What Does Your Insurance Cover?

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 Insurance Cover

Many of our patients have health insurance plans that cover the cost (including co-pay) of a "yearly preventive health care visit" - otherwise known as your "annual" - some(i.e. Medicare) do not include touching the patient! HFM does so anyway, for "free."

Generally, you may expect that your provider will do the following as needed:

  • Gather or update your comprehensive medical history
  • Outline plans for the reduction of risk factors
  • Provide interventions or counseling to improve overall general health
  • Order appropriate laboratory/diagnostic procedures
  • Order and/or administer appropriate immunizations
  • Manage minor health concerns

"Minor health concerns" include the following and other similar concerns:

  • Obtaining a refill prescription for chronic, routine, simple, single, medication. (allergy or birth control, for example) - not a whole list of serious medications.
  • Asking your provider to pay special attention to a skin lesion during the exam.

More specific or extensive health concerns are not covered. These are issues that would normally prompt your to schedule an appointment if our were not scheduled for your "annual." If time permits, some of these concerns may be addressed at the time of your "annual,' however, according to your insurance guidelines, HFM will generate a charge for an office visit, which would include a co-pay. If time does not permit, we can schedule a separate appointment.

Following are examples (not a complete list) of specific health concerns that would not be covered as part of your "annual."

  • A sinus infection or new cough
  • Sore throat (and testing for strep)
  • Significant review of a consultant's work
  • New or changed headache pattern
  • Abdominal or pelvic pain
  • Depression or anxiety
  • Joint pain, specific or general
  • Sleeping problems
  • Irregular periods
  • Significant changes in status of a chronic health problem
  • Any Procedure (ears, joint inject, etc.)

As it is very common (far more than not) for "annual" visits to stray into "specific health concerns" or even be planned and scheduled that way (a very good idea) and wishing to minimize inconvenience to our patients and our staff, HFM will collect the usual co-pay at your arrival. It will be refunded to you (or credited to your account -- your choice) on departure if the visit was in fact limited to only an "annual" review. Please feel free to remind your provider to indicate on your service record if this was the case - it is at their discretion.