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Why Did I Get a Bill for My Annual Exam?

Annual preventive exams are designed to focus on maintaining your health and are often covered by insurance at no cost to the patient. However, certain situations may lead to receiving a bill for services provided during your annual visit. Here’s why:

1. Additional Services Were Provided

If your provider addresses concerns beyond the scope of a preventive exam—such as diagnosing or managing a specific medical issue, prescribing medication, or ordering additional tests—these services are billed separately and may not be fully covered under your plan’s preventive care benefits.

 

2. Your Insurance Plan May Not Fully Cover Preventive Care

While most insurance plans cover annual exams, coverage can vary. Some plans may require cost-sharing, like copays or coinsurance, even for preventive services. Always check your insurance benefits to confirm your coverage.

 

3. Your Deductible Hasn't Been Met

Preventive services are typically exempt from deductibles. However, if additional services are provided that fall outside of routine preventive care, those charges may apply to your deductible, requiring you to pay out-of-pocket.

4. The Provider or Facility Was Out-of-Network

If you receive care from a provider or facility not included in your insurance network, you may be responsible for a portion of the charges. Verify that all providers involved in your care are in-network before your visit.

 

5. Coding or Billing Errors

Sometimes, services performed during your visit may be incorrectly classified. For example, a preventive service might be coded as diagnostic. If you believe your bill includes an error, contact our billing department to review the charges, and check with your insurance company to confirm how the visit was coded.

 

How to Avoid Unexpected Bills

  • Understand Your Insurance Benefits: Review your plan’s details to know what’s included under preventive care.

  • Communicate with Your Provider: Let your provider know you’d like to stay within the scope of a preventive visit. If additional concerns arise, ask if they can be addressed at a separate visit.

  • Verify Provider Network Status: Ensure your provider and facility are in-network to avoid higher out-of-pocket costs.

If you’re unsure why you received a bill for your annual exam, review your Explanation of Benefits (EOB) from your insurance company and contact our billing office for assistance. We’re here to help you understand your charges and resolve any questions.

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