Types of Office Visits
When you schedule an appointment with our office to see one of our doctors or physician assistants, it may be for any number of reasons. You may be experiencing an acute illness, require a periodic review of a chronic condition before medications can be refilled, or simply because you wish to have a periodic check up or routine physical. Because every patient’s insurance coverage varies, it is important that you understand the difference between a “physical” or "wellness exam" and a “sick visit,” accurately informing the physician of the reason for your visit at the outset of the encounter. That reason is documented in the physician’s encounter note that goes in your chart.
If you are being seen for treatment of symptoms that relate to an illness or other medical condition, whether acute or chronic, we consider that to be a “sick visit.” Hypertension, sore throat, difficulty breathing, diabetes, etc. are all reasons that patients are seen for a sick visit.
If you are experiencing any sort of symptoms, your physician will most likely categorize your visit as a sick visit, and the examination they perform will be limited to the body systems involved with that illness. In virtually 100% of all cases, insurance plans provide coverage for sick visits to the doctor and you will be responsible for your co-payment, deductible or coinsurance according to your particular plan. If you do not have insurance coverage or choose to file on your own, our cashiers can give you the information you will need to file a claim.
Physical or Wellness Examination
For patients who are otherwise healthy and who wish to have a general physical exam, our doctors are more than happy to provide that service. Generally, a physical or wellness examination will focus on all parts of the body, whether any symptoms exist there or not, and may involve some general laboratory tests to screen for potential problems.
Some employer-paid insurance plans provide coverage for periodic general physical exams, but many do not. If the plan does not cover the physical, the patient will be responsible for the charges associated with that service. For patients covered by Medicare, understand that Medicare does not cover physical exams where no illness is present.
The physicians of Woodlands Diagnostic Clinic believe that patients should receive general wellness exams on a periodic basis, depending on their age and overall health status.
Both Physical and Sick Visits
On occasion, a patient may come in for a sick visit and may ask for or agree to a general physical or wellness exam. In those cases, the physician will provide both services, reviewing the patient’s specific health problems but also performing an overall wellness check. When this occurs, the doctor will mark both a sick visit and a physical on the charge ticket. Both services will be filed with the patient’s insurance and we will coordinate the balance due between the two charges, since the doctor already did a portion of the physical when evaluating the patient for their illness, and vice versa.
If the physician orders any laboratory tests, it is important for the patient to understand that any screening tests done for wellness purposes will likely fall under whatever physical benefits for which he or she has (or does not have) coverage. If the patient does not have wellness coverage then the patient will be responsible for any lab tests ordered for screening, or wellness, purposes.
We understand that this is confusing, but we are required by Medicare and by our various insurance contracts to accurately report the services that we render so that they only pay for what they are financially obligated to do so. Our documentation supports the services that we render to our patients so we will not be able to go back later and amend that documentation to help a patient get better reimbursement from their insurance company.
Your insurance coverage is your responsibility. There are literally thousands of types of coverage available, and we are unable to keep track of all of them. It is important that you be familiar with your benefits and coverage, whether provided by your employer, by Medicare or by your own private plan. Our business office will assist you in any way they can by answering your questions or working out payment arrangements if you have a balance due on your account.
The physicians of Woodlands Diagnostic Clinic are committed to providing quality care at a reasonable cost to our patients. Your clear understanding of our financial policy is important to our professional relationship. To assist us in our efforts to collect the appropriate amounts due to the clinic, we ask that you:
Always supply us with current and complete insurance information. We will ask you for a copy of your insurance card at each visit, and ask that you update any changes in your demographic information.
Pay in full for all co-payments, deductibles, and non-covered services at check-in or check-out.
Provide WDC and your insurance company with any additional information requested to complete processing of claims filed on your behalf.
Authorize release of information as necessary, by signing a patient registration form at each visit.
We have contractual agreements with many managed care plans. Each time that you make an appointment with one of our physicians, it is your responsibility to make sure that your provider is contracted with your plan. We may require verification of coverage and benefits before you are seen. If you have questions about provider participation with your insurance plan, please contact scheduling or our business office.
If you are covered by an insurance that your physician is not contracted with, or you have no insurance coverage, you will be treated as self-pay, and will be responsible for payment
in full at time of service. If you request it, we will provide you with an itemized statement that you can use to file with your insurance carrier.