Office visit, preventive visit or annual wellness visit — will you get a bill? What’s the difference?

Story by: Sara Thompson on September 28, 2022

A doctor’s office visit requires a few things: health insurance card, a photo ID and a method of payment. How insurance is billed (and potentially what you may owe) for your visit depends on what kind of appointment you have: preventive visit, office visit or annual wellness visit. What’s the difference between an office visit and an annual wellness exam? What’s a preventive care visit? Read on for how to tell the differences among the these types of doctor visits and how insurance might affect your bill.

What is preventative care?

Preventive care, or a “physical” includes a general physical exam, a thorough review of your health and well-being and any new symptoms and health concerns.

“These visits help your doctor find health concerns early, before they become a bigger issue,” said Monalisa M. Tailor, M.D., internal medicine physician with Norton Community Medical Associates. “As the name implies, we are preventing health issues.”

During a preventive care visit (physical), a nurse might take your blood pressure and pulse, and ask if anything has changed since your last visit, including new prescriptions or health-related events.

Preventive care includes:

• Flu shot and other vaccinations (such as boosters for pneumonia, Tdap, etc.)
  • Mammogram (one per calendar year, typically after the age of 40)
  • Colonoscopy (usually one every 10 years after the age of 45)

Most preventive care is covered at 100% by insurance. Call your insurance company and ask about your responsibility for copays, coinsurance and deductibles.

What is an office visit?

If you have new or worsening symptoms of a chronic condition, you might need an office visit.

“These visits are designed to help you manage an ongoing health issue or learn more about a new health concern,” Dr. Tailor said.

Office visits can include:

• Questions about your health concerns, worries and symptoms
  • Advice and education
  • Drug prescriptions
  • Referrals to a specialist
  • Tests such as bloodwork or X-rays

Ask your insurance carrier if office visits are covered and how much you can expect to pay for deductibles, copays or coinsurance.

What is an annual wellness visit?

An annual wellness visit (AWV) helps the doctor make or update your personalized plan based on current health and any risk factors. You fill out a health risk assessment that asks questions about your habits, diet and lifestyle in order to help you set goals for health or stay healthy.

An AWV includes:

• Review of your family health history and your medical history
  • Review of current health care providers
  • Review of medications and supplements
  • Routine measurements including height, weight, blood pressure and pulse
  • Evaluation of health risk factors and possible treatment options

Typically, there is no cost for an AWV. You should check with your insurance provider about copays, coinsurance and deductibles, or to understand how Medicare Part B applies to an AWV.

“All three of these types of visit help your doctor help you stay healthy,” Dr. Tailor said.