What is the difference between a physical and an office visit?

Preventive care (Annual Physicals, Well Child Exams, and Wellness Exams) are services to catch health problems early. Usually, these preventative services are covered by your insurance company with little to no out of pocket cost to you. The distinction between a “physical” and an “office visit” is especially important when we submit a bill to your insurance company for that visit. However, understanding what your insurance will cover at your preventative visit creates some confusion for many of our patients. Therefore, here are some clarifications:

What is preventative care?

A “physical” or “preventive health exam” is a thorough review of your general well-being. The doctor will review your medical problems, perform a complete physical examination and make recommendations concerning your health. This may include general recommendations regarding diet and exercise, age appropriate immunizations and cancer screening exams.

What is an office visit?

An “office visit” is an appointment time to discuss new or existing problems. The questions and exam will focus on the problems discussed. This is different from preventative care. Hence, if you schedule a physical but your appointment is spent on specific health issues or problem(s), we can no longer bill this as a physical, but instead, as a problem-focused “office visit”. Please do not ask your provider to change your office visit to a physical, change your diagnosis, and/or change the billing amount to your insurance company. This is considered “fraudulent” billing behavior by your insurance company and federal regulatory agencies. Meaning, what we bill to your insurance company for payment must be consistent with the visit notes and exam.

Some common preventative care services include:

For Adults
  • Cholesterol screening
  • Colon cancer screening
  • Diabetes screening
  • Review of past history (surgical, family, social)
  • Immunizations
  • Routine physical exam
  • Fall risk screening
  • Depression screening
  • Dementia screening
  • Alcohol screening
  • End of life planning and DNR’s
  • Family Planning services:
    • Contraceptive and family planning/counseling
    • Contraceptive devices and contraceptive drugs
Additional Services for Women
  • Breastfeeding support, supplies, counseling
  • Prenatal care
  • Antepartum care
  • Routine mammograms
  • Routine Pap tests
For Children
  • Newborn hearing screening
  • Immunizations
  • Periodic well-child visits
  • Sexually transmitted infection (STI) screening and prevention counseling for adolescents
  • Vision screening