PREVENTIVE MEDICINE VISIT CONSENT
You are being seen for a Preventive Medicine Visit (aka Annual Physical Exam, Well Woman Exam, etc.). This is a specific service designed to screen for and prevent health issues. It may include a physical exam, labs, counseling, and/or immunizations depending on your individual risk factors.
In most cases, the Preventive Medicine Visit is free to you. The Affordable Care Act obligates most insurance plans to pay for this service without charging you.
However, there are important exceptions:
The evaluation and management of EXISTING and NEW health issues is NOT covered under the Preventive Exam. Insurance companies regard these issues as separate and distinct from the Preventive Visit. Usually, time does not allow for the appropriate and thorough evaluation of these conditions during your Preventive Visit, and an additional appointment needs to be scheduled. If you and your Physician or Provider do address new or existing issues, it will generate charges that will be your responsibility. This may include medication refills and management of chronic conditions. Your insurance company may not apply those charges to your deductible, copayment, or coinsurance, and you are completely responsible. You are welcome to schedule another appointment to discuss issues that are not Preventive, and at that time your deductible, copayment, or coinsurance will apply for In-Network plans. Please let the staff know now if you would like to schedule another appointment.
If your medical concern is unable to wait until our next available appointment, we may reschedule your Preventative Medicine Visit and address your medical problem or concern instead. Please note, your appointment will be subject to your deductible, copayment, or coinsurance based on your insurance plan and will be due at the time of service.
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