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How Health Insurance Coverage Affects Annual Physicals

2010-09-03

An annual physical as part of a preventative care program is often an excellent way to catch issues before they become serious. But it's often mind-boggling trying to understand what is and isn't covered as part of your health insurance plan, and many tests that you or your doctor might request might not covered by insurance. It's important to understand what your insurance company's specific rules are on preventative care and annual physicals to prevent billing surprises later on.

Some recent studies have challenged the conventional wisdom that adults need to get an annual physical, instead recommending that apart from yearly colon screenings, gynecological exams, etc., healthy adults abstain from seeing their doctor yearly for a head to toe exam. But many health care professionals still recommend annual physicals as part of a general plan of preventative care. In an era when heart disease, cancer and other silent killers are taking an incredible number of lives, many health care professionals and organizations still treat annual physicals as a must.

Generally, most health insurance companies will cover a yearly physical. Some insurance companies do have limits as to what parts of annual physicals they'll cover. These limits often depend on your location, specific plan, benefits already used and tests and procedures that have been ordered.

It's important that you realize what tests your health insurance company will cover. Some tests that are often ordered or expected by the patient are actually not covered by insurance and thus, extremely expensive and possibly unnecessary. CT scans, full body scans and other similar tests are often not covered as part of a normal physical. Some insurance plans that do not cover annual physicals will give you a lowered rate on your physical. Generally, if your insurance company does not pay for annual physicals, you can expect to pay several hundred dollars for your exam.

It should be noted that while Medicare does cover certain preventative tests, generally it does not cover annual physicals.

Most rules regarding annual physicals and other preventative care do not apply to infants, children and pregnant women. These groups of people obviously do require checkups more often and are thus usually covered by most health insurance companies. With the recent introduction of new health care legislation, there are new stipulations about covering preventative care. New plans taking effect in the fall will be required to cover certain aspects of preventative care.

Preventative care is an important part of your health care routine. As long as you become familiar with your insurance plan and what it covers, you can make sure that you and your family's physicals don't cost you exorbitantly out of pocket.

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