What are:

Wellness exam, physical, follow-up visit. If you’re confused about the differences among these terms, you’re not alone.

At Jackson Family Practice, our goal is to help you understand the different types of office visits we offer so you know what to expect. Here  are descriptions of each one, as well as the services provided and what insurance may or may not cover. These are general guidelines only. Your insurance company’s coverage might be different, and it’s important to know your benefits prior to scheduling an appointment. We encourage you to familiarize yourself with what your insurance plan offers. Visit your insurance company’s website for details.

  • New Symptom

    Patient- New Problem/Symptom
    An appointment to investigate a new symptom—such as chest pain, weight loss, or depression. Oftentimes, the problem may be quite complex, with multiple symptoms that require diagnostic tests and follow-up visits.

    Does Not Include:
    Medication refills for other problems or review of preventive services.

    Insurance Coverage:
    Covered by almost all insurance, including Medicare and Medicaid.

  • Follow-Up/Chronic Care

    Follow-Up/Chronic Care
    A visit to review chronic problems, adjust medications, check laboratory monitoring, or refill prescriptions. For some simple chronic problems (e.g., allergies), this may be once a year. For more significant problems, it may be at least twice a year. Certain types of prescription medications are required to be followed up on with a visit every 3 months

    Does Not Include:
    Review of preventive services.

    Insurance Coverage:
    Covered by almost all insurance, including Medicare and Medicaid.

  • Sick Visit

    Sick Visit
    When you are not feeling well or experiencing acute symptoms not related to any chronic issues a sick visit is what you need. Typically scheduled the same day or as soon as possible to get you back to work, school or play.

    Does Not Include:
    Review of preventative services, chronic care, medication refills, follow-up or new symptoms..

    Insurance Coverage:
    Covered by all insurances..

  • Yearly Preventative Physical

    Well Exam for Man, Woman or Child
    An exam on a healthy person with no symptoms to look for hidden disease and give advice on healthy behavior. Getting the right preventive services at the right time can help you stay healthy by preventing disease or by detecting a health problem at an early stage when it may be easier to treat.

    Does Not Include:
    Medication refills, evaluation of new symptoms, or management of chronic problems.

    Insurance Coverage:
    Covered by most insurance. Not covered by Medicare, but may be covered by secondary insurance if Medicare patient has that.

  • Medicare Wellness

    Also known as “Welcome to Medicare” & “Medicare Preventative Visit”
    Specialized planning visit to review which Medicare preventive services you need. Medicare requires that a standard set of questions be asked. They must include: review of functional status, depression screening, list of special medical equipment (if any), and list of other doctors. At the end of the visit, you receive a written summary of the services you require that are covered by Medicare. These might include cancer screening tests, EKG, blood tests, bone density tests, ultrasound, etc. Your first yearly wellness exam cannot take place within 12 months of your “Welcome to Medicare” physical exam. Most Annual Wellness Visits most take place 365 + days apart.

    Does Not Include:
    Medication refills or evaluation of new symptoms.

    Insurance Coverage:
    Medicare pays in full. There is no co-pay or deductible.

    Resources:
     More complete information can be found at www.healthcare.gov, a federal government website managed by the U.S. Department of Health & Human Services.

  • Administrative Physical

    Administrative Physicals
    Camp physicals, school physicals, work physicals, insurance physicals—this type of visit requires the doctor to fill out a form. Services include whatever is necessary to fill out the form.

    Does Not Include:
    Medication refills or evaluation of new problems.

    Insurance Coverage:
    Sometimes covered by insurance, but often not. In cases where a form is needed a short time after an appointment (i.e., child had an annual Well Child Exam to update immunizations and three months later needs a form filled out for camp), the doctor may be able to complete the form without another visit. However, there is a fee to fill out the form and that fee is usually not covered by insurance.

  • Procedure Visit

    Procedure Visit
    Removal of moles, skin tags, wart’s and minor dermatological procedures as determined necessary from a previous office visit. This is typically a lengthy visit and at times will include sending a specimen for patholical review.

    Does Not Include:
    Medication refills or evaluation of new problems.

    Insurance Coverage:
    Billed to insurance, paid according to your plan, including Medicare and Medicaid.

  • Wellness Infant - 18

    Preventive/Wellness for Infant – 18
    Well-child visits are key times for communication. Expect to be given information about normal development, nutrition, sleep, safety, and other important topics such as what to expect as your child grows up. Important growth records are updated and evaluated as well as immunizations given at these visits.

    Does Not Include:
    Sick visit or chronic care visit..

    Insurance Coverage:
    Billed to insurance, paid according to your plan, typically without paying a co-pay, deductable or co-insurance.  It is important to review your child’s insurance plan schedule for Well-Child visits.

  • New Patient

    New Patient Visit
    Your first visit to Jackson Family Practice will involve review of systems, vitals and general update of your health. Completing medical history and family medical history are essential at this visit. This visit can be combined with over visit types.

    Does Not Include:
    Procedure Visit, Medicare Wellness Visit or Yearly Preventative.

    Insurance Coverage:
    Billed to insurance, paid according to your plan.

Visits Q & A

Coding for Your Insurance

The difference between medical services is sometimes hard to understand. As a physician practice, FFPC does not control these differences. Our reimbursement is based on the coding system that insurance companies use to describe medical work. For example the coding system classifies a physical exam and medication refill as two separate services. Think of it this way: you wouldn’t expect to make a restaurant reservation for three people, and then bring a fourth person for free. Or have a plumber come to fix a leaky sink and install a dishwasher for no extra charge. The same is true for medical services.

Can I combine services?

For your convenience, the provider may combine two types of services at one visit — a Well Man Exam and a chronic care visit to refill blood pressure medication, for example. Many factors determine if we are able to do this at a particular visit, how well a medical condition is under control, a new more urgent problem is present  and the general health of the patient is all a consideration. However, because these are two different services, there would be two separate charges. We may collect two co-pays at the time of your visit and submit two charges depending on your insurance benefit.

How do you decide what to focus on during an exam?

Providers are taught to examine literally thousands of physical signs—from knee reflexes to heart sounds. When conducting an exam, the doctor relies on your personal medical history in combination with any current symptoms or problems. Sometimes, specific symptoms such as a heart murmur or rash will be the actual diagnosis. Your medical history is always the first important consideration.

How do you decide what tests and services I should have?

Providers are specially trained to evaluate the usefulness of tests and preventive services and help you decide which ones are right for you. We offer advice on immunizations, X- rays, blood tests, and a host of other special procedures. Generally, testing is based on your age, health history, and risk factors. We rely on information from the United States Preventive Services Task Force to guide our recommendations.