When does preventive care become problem-oriented care?
Think of your preventive care physical as being similar to a dental cleaning. The cleaning – just like a physical exam – covers set services for you. If you have X-rays at the dentist’s office or need cavities filled, those services are billed separately. So, services or needs above and beyond your physical exam are billed separately as well.
Here is an example of how a preventive care physical exam can turn into problem-oriented care:
You’re seeing a provider for your annual preventive care physical and, as she’s listening to your lungs, you mention that your wrist has been hurting a lot lately. You tell her your hand is weak and hurts when you type, and you can’t help but wonder if you’re developing carpal tunnel syndrome. Asking that requires the provider to deliver problem-oriented care.
By asking that question, the physical exam changed from a preventive care situation to a problem-oriented care situation. Because of that, HSHS St. Clare Memorial Prevea Health must charge separately for services outside the scope of the physical exam.
You should ask questions. However, due to the limited amount of time allotted for your physical exam, you are welcome to make a separate appointment to ensure your questions are thoroughly addressed.
If you have specific questions about what may or may not be covered by your insurance, please contact your insurance company before your physical exam. Your insurance company may not cover all services performed outside of your physical (such as screening tests or lab work).
If you have questions about the costs associated with your care, please contact HSHS St. Clare Memorial Prevea Health at 920-846-2521. All other questions about problem-oriented or preventive care can be addressed by your local health center.