Wellness Visit Care Options
- Brandon Larsen
- Oct 27, 2024
- 6 min read
Are you due for a wellness visit or annual physical?
Consider these factors to determine if it's time:
Time Elapsed: Has it been a year (or the recommended interval) since your last checkup?
Age and Health Status: Do you have any existing medical conditions that require regular monitoring?
New Concerns: Have you noticed any changes in your health or developed new concerns?
Preventative Care: Are you up-to-date on recommended screenings and vaccinations based on your age and gender?
Family History: Do you have a family history of certain diseases that warrant regular checkups?
Employer Incentives: Does your employer offer incentives or rewards for completing an annual wellness visit?
Be aware that discussing certain topics or refilling prescriptions during your wellness visit may change it to an evaluation and management (E&M) visit, which could incur a cost-share. However, regular wellness visits are crucial for preventive care, early detection of potential health issues, and overall well-being.
Explore these care options for your wellness visit/annual physical:
Preparation for Your Visit:
Gather Medical Records: Collect any relevant medical records, test results, or a list of medications you're currently taking.
Prepare Questions: Write down any questions or concerns you want to discuss with your doctor.
Family History: Be prepared to share your family's medical history, including any chronic diseases or conditions.
Lifestyle Information: Be ready to discuss your diet, exercise habits, sleep patterns, and any other relevant lifestyle factors.
Ask About Coverage: Before your visit, confirm with your doctor's office and insurance provider what is covered under a wellness visit versus an E&M visit.
Telehealth Options:
Virtual Consultations: While not a substitute for a comprehensive physical exam, telehealth visits can be useful for discussing specific concerns, reviewing test results, or refilling medications.
Specific Companies: Teladoc, Amwell, MDLIVE, PlushCare, and others offer virtual primary care services.
Finding Your Telehealth Match: Telehealth isn't one-size-fits-all. Some companies excel at general care, others specialize in specific conditions. Compare specialties and costs to find the best fit for your needs. Try Teladoc, Zocdoc, Sesame Care, Amwell, and Doctor on Demand.
Finding Cost-Effective In-Person Care:
Use your insurance provider directory to find in-network doctors.
Explore online directories like Zocdoc or Healthgrades to find available providers.
Use turquoise.health to compare prices for provider visits, location of care, tests, and procedures.
In-Person Care Options
Primary Care Physician (PCP): Your PCP is your main healthcare provider and can conduct a comprehensive physical exam, order lab tests, and discuss preventive care measures. (Cost: $100-$300 per visit, often covered by insurance)
Nurse Practitioner (NP) or Physician Assistant (PA): NPs and PAs can also perform wellness exams and provide preventive care services. (Cost: similar to PCP)
Concierge Medicine: This membership-based model offers personalized care, longer appointments, and enhanced access to your doctor. (Cost: higher than traditional PCP, typically a monthly or annual fee)
Direct Primary Care (DPC): Similar to concierge medicine, DPC offers a membership-based model with comprehensive primary care services, but often at a lower cost.
Lab and Imaging Options
For the most cost effective care use an in-network, free-standing facility.
Blood Tests:
Complete Blood Count (CBC): Checks for anemia, infection, and other blood disorders.
Comprehensive Metabolic Panel (CMP): Evaluates liver and kidney function, electrolyte balance, and blood sugar levels.
Lipid Panel: Measures cholesterol and triglyceride levels.
Thyroid Function Tests: Assess thyroid hormone levels.
Other Tests: Your doctor may order additional tests based on your age, risk factors, and medical history.
Imaging:
Mammogram (for women): Screens for breast cancer.
Colonoscopy (for adults 50 and older): Screens for colon cancer.
Other Imaging: May be ordered based on your individual needs and risk factors.
Vaccinations:
Discuss with your doctor: Review your vaccination history and discuss any recommended vaccines based on your age and health status.
Recommended Care Pathway for Wellness Visits/Annual Physicals
Schedule Your Visit: Contact your PCP or chosen healthcare provider to schedule an appointment.
Prepare for Your Visit: Gather your medical records, list any concerns, and be ready to discuss your health history and lifestyle habits.
During Your Visit:
Comprehensive Physical Exam: Your doctor will perform a thorough physical examination, including checking your vital signs (blood pressure, heart rate, etc.), listening to your heart and lungs, and examining your abdomen.
Discuss Your Concerns: Share any questions or concerns you have about your health.
Clarify Coverage: Ask your doctor what topics or services are covered under your wellness visit and which ones might incur additional charges.
Review Your Medical History: Update your doctor on any changes in your health or medications.
Lab Tests and Imaging: Your doctor may order blood tests or imaging studies based on your age, risk factors, and medical history.
Vaccinations: Discuss any recommended vaccinations and get them updated as needed.
Personalized Health Plan: Collaborate with your doctor to develop a personalized plan for preventive care, including diet and exercise recommendations, screenings, and lifestyle modifications.
Follow-Up: Schedule any necessary follow-up appointments for further testing or treatment.
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Meet Carmen:
Carmen, a dedicated employee, had recently learned about a fantastic incentive offered by her employer's wellness program - a $200 bonus for completing an annual physical. This sparked her interest, as she had been meaning to schedule a checkup anyway. Plus, the extra cash would certainly come in handy.
She also needed to refill a prescription for her allergies, but she had been experiencing some unusual pelvic pain lately. Carmen wondered if she could address both issues during the wellness visit, so she decided to call her primary care physician's office to inquire about the details.
Upon speaking with the office staff, Carmen learned that while the annual physical would cover a comprehensive review of her health history, basic screenings, and preventive care measures, it would not include a refill of her prescriptions nor a diagnostic evaluation of her pelvic pain. The staff explained that any specific medical concerns or symptoms would require a separate appointment, which may not be fully covered by her insurance.
“This is what’s wrong with healthcare!” Carmen thought as she was disappointed to hear this, because she didn't want to incur additional out-of-pocket expenses. However, she was still determined to take advantage of the wellness visit incentive. She reasoned that she could get her general checkup and screenings done now and address the pelvic pain issue later through a virtual care visit, which might be more affordable.
On the day of her appointment, Carmen arrived at the doctor's office feeling a mix of excitement and apprehension. She was eager to take advantage of the wellness benefit but also nervous about the mammogram and other screenings.
The nurse greeted her warmly and led her to a private room, where she took Carmen's vital signs and asked her some preliminary questions about her health history. The doctor then came in and conducted a thorough examination, reviewing Carmen's medical records and discussing her lifestyle habits.
During the exam, Carmen expressed her concerns about the pelvic pain she had been experiencing but said that she knew it was not covered in this visit and could not afford to pay the cost share at this time. The doctor listened attentively and explained it was important to investigate the cause of her pain. She recommended scheduling a separate virtual appointment to discuss her symptoms in more detail and determine the appropriate course of action.
Somewhat satisfied with this plan, Carmen proceeded with the rest of her wellness visit. She underwent routine bloodwork, a mammogram, and other age-appropriate screenings. The doctor also provided her with personalized health advice, discussing strategies for stress management, nutrition, and exercise.
Carmen left the appointment feeling empowered and informed. She was grateful for the opportunity to take charge of her health and receive preventive care. While she still had to address her pelvic pain and prescription refill issue, she felt reassured knowing that she had taken the first step towards maintaining her overall well-being.
A few days later, Carmen scheduled a virtual appointment with her doctor to discuss her pelvic pain and prescription refill. The doctor sent a new prescription to Carmen’s pharmacy and listened carefully to her description of the symptoms, asking questions about the location, intensity, and duration of the pain. Based on their conversation, the doctor suspected a possible urinary tract infection (UTI) and recommended a urine test to confirm the diagnosis.
Carmen followed the doctor's advice and scheduled the test at a local, freestanding (not in the hospital) lab that was in network. The results confirmed the UTI, and the doctor prescribed a course of antibiotics to treat the infection. Within a few days, Carmen's pelvic pain subsided, and she felt relieved to have finally resolved the issue.
Carmen's experience highlighted some of the issues with the healthcare system and the importance of regular wellness visits in preventive care and early detection of potential health issues. By taking advantage of her employer's wellness program, she was able to receive a comprehensive checkup, identify potential risks, and address a pressing medical concern. She also learned the value of virtual care in providing accessible and affordable healthcare options.
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