You’ve been on your body-smart game, Betty.
Well-woman exam: booked, attended, and healthy!
But then a few weeks later, you get sidled with a medical bill for the appointment you expected to be covered in full. Excuse me?!
Surprise bills are fun for no Betty so we’re back with another healthcare explainer: well-woman visits vs. problem visits.
WHAT IS A WELL-WOMAN VISIT?
A well-woman visit is a Betty’s once-a-year checkup with their GYN provider. Depending on your age + your provider’s recommendations, this visit usually includes:
– a breast exam
– pap test
– 1:1 chat about your health goals
If you have insurance, typically, this appointment is classified as a preventive visit and is completely free for you! That’s right: no copay, zero lab fees; nada fees associated with the visit should cost you a dime.
BUT. This freebie has a few exceptions.
During your well-woman, if you bring up a new concern, your preventive visit just became a problem. A problem visit, that is.
WHAT IS A PROBLEM VISIT?
A problem visit addresses issues outside your preventive care. If you do have concerns like abnormal bleeding or irregular periods, vaginal infections like yeast or bacterial vaginosis, urinary issues or UTIs, etc., these should be addressed in a separate appointment.
Still confused? Try on this metaphor. Think of your well-woman visit like your routine teeth cleaning. Every six months or so, we head to the dentist for a *swish,* floss, and polish to prevent any future dental problems. But let’s say, during your cleaning, the hygienist sees symptoms of gum disease and recommends a deep cleaning. Because the check-up has gone beyond the ol’ standard, you may be charged for the extra steps to address the issue. Make sense?
i gotcha. so HOW EXACTLY DOES A PREVENTIVE VISIT turn into A PROBLEM VISIT?
When you bring up a concern that goes off the well-woman appt. script, your provider is required by law to code accordingly.
coding:
Coding is basically a clinical statement from your medical provider that communicates, “Here’s what happened during the visit.”
When your provider codes an appointment as a problem visit, this triggers to your insurance, “We’ve entered into a different visit type.” And unlike your well-woman exam, this visit might come with fees attached. You may now have a copay and be charged lab fees or some portion of your visit.
@bettys_co betties, you might’ve assume your insurance was picking up the tab for that annual gyn visit. that is until… suprise!🤨 doctor’s bill!🥸 know what’s covered + what’s not, so you can share any cost concerns with your provider during your well-woman! #gyn #insurance #healthinsurance #wellwomenexam #wellwoman #wellwomanexam #annualexam #gynecology #gynappointments #insurancetips #fypシ ♬ Astro Beat – Staysee
UGH. NOT COOL.
We hear you, Betties! The preventive vs. problem distinction is a nuance that is not very well known and insurance varies widely in what they will or will not cover.
HOW CAN I PREVENT A SURPRISE BILL?
Know before you go
Give your insurer a call before your visit to confirm how they interpret the guidelines.
Clarify the cost
If you have concerns during your appointment, hit pause, and ask your provider, “Does my well-woman/preventive exam cover this? If not, how much will it cost?”
You + your provider share the same goal: your health! Voicing financial concerns helps the joint decision-making process to create the best care plan for you.
book your well-woman
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