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What is the Difference Between a Physical and an Office Visit?

By CHI Health Primary Care Team March 16, 2021 Posted in: Wellness

If you’re confused about the different visit types you’re not alone. At first glance, a physical and an office visit may seem like the same thing…but there is a difference, and it’s important to understand because the services offered, and coverage by insurance, are distinctly different.

In our clinics, our providers strive to make every visit useful and meaningful. Ensuring that your appointment is scheduled correctly helps you get the right service and helps us serve your needs the best we can.

These are general guidelines only and it is important to know your insurance benefits prior to scheduling an appointment.

Physical/Annual Exam

This is a yearly visit that is focused on your overall well-being and disease prevention. We review your medical history, perform a screening physical exam, and discuss any preventative services recommended for your age, gender, and state of health. If immunizations, cancer screenings or other preventative services are recommended, they will be ordered and/or performed at this visit. These visits are also referred to as well woman exam, well male exam, or well child check. When you schedule one of these visits, you should emphasize that you are scheduling a preventative visit. That way, we can do our part to ensure the contents of the visit do not include things that would trigger an “office visit” code to be generated and billed out.

  • Does Not Include: Medication refills, evaluation of new symptoms, or management of chronic problems.
  • Insurance Coverage: Covered by most insurance companies. However, if new medical issues are discussed or chronic problems are managed, there may be an office visit charge.

Office Visits

Most of the time, patients are seen for an office visit. This is an appointment time to discuss new or existing problems. Depending on the complexity of the concerns, and to ensure the highest quality of care, you might be asked to return for a follow up visits to ensure there is enough time to address your needs. These visits are often referred to as “med-checks” or “follow up” and may include refilling prescriptions, prescribing new medications, ordering additional tests like lab or x-ray, in office procedures, and/or referral to specialists. For some simple chronic problems (e.g., allergies), this may be once a year. For more significant problems or uncontrolled problems, it may be as often as needed as determined by your provider to work toward controlling the problem.

  • Does Not Include: Review of preventive services.
  • Insurance Coverage: Covered by almost all insurance, including Medicare and Medicaid. Co-pays and deductibles may be applied.

If you are unsure about your visit type, feel free to call and ask questions to any of our clinic locations.

CHI Health Primary Care Team
CHI Health Primary Care Team

These blogs were written by the CHI Health Primary Care Team.

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