Health Care 101 – Be Well!

Part 2 in our series to introduce you to some basic concepts about your health care.

 

As health care providers, our main goal is that you be healthy and stay healthy. There are many ways that can be accomplished, understanding that life doesn’t always cooperate.  It’s important to know that other partners in your health care, including your insurance company, want you to stay healthy too. If you haven’t seen the doctor in a while to discuss your health, it is probably time to do so.

One of the landmark provisions of the Affordable Care Act is the provision of full payment for Preventive Health Exams (PHE). These exams are specifically designed to catch health issues before they start, and include a number of screenings for this purpose. In the women’s health world, this is called the “well-woman exam” or “annual exam” and includes the following items:

Overall assessment of:

• Health status
• Menstrual/contraceptive status
• Physical Activity
• Sexual practices
• Tobacco, alcohol and drug use
• The need for periodic health screening tests (e.g., Pap Test, cholesterol, mammograms)
• Discussion of specialty-appropriate medication refills

A gynecologic-oriented physical exam, including:

• Height, weight and body mass index (BMI)
• Blood pressure
• Abdominal exam
• Breast exam
• Pelvic Exam

Other tests that may be performed:

• Vaccinations for flu, Hepatitis A&B, human papillomavirus (HPV), tetanus/Tdap and measles.
• Chlamydia and gonorrhea
• HIV testing for sexually active adolescents and women

What’s important to realize in this, and any other Preventive Health Exam is that it is intended for the well person, and the assumption is you do not have a specific medical problem or condition to discuss. The purpose is to evaluate for health issues that are unknown, rather than treating a health issue that is already happening. Physician offices, including Madison Women’s Health, schedule a specific amount of time to cover the Preventive Health Exam, however, other issues that are discussed (“problem-oriented”) are usually not accounted for in the scheduling of the visit.

Also, your insurance company will cover the full cost of the part of any visit that is considered preventive health. However, if you have a discussion of a specific problem (i.e., skin rash, sleeping disorder, anxiety/depression), this is considered a health problem and you may be charged for this part of the visit since it is not considered “preventive health”.  This would be similar to if you scheduled a separate visit to come in and talk about that particular problem. It is important that you know your health benefits and how the services you will receive will be covered before you go in.

Here are a few tips before you schedule your “annual physical”:

• When you call to schedule your visit, be sure to let the scheduler know if you have any other concerns or issues to discuss with the physician (i.e., problems). They may set aside extra time in the visit or suggest a different time to discuss that problem.
• If you discuss a problem during your preventive health exam, understand that you may have a charge for the discussion or treatment of that problem. You can always contact your insurance company to help you understand how discussion of a certain problem might be covered under your health benefits.
• Do not save up all of your health concerns for your preventive health exam. If you have a current chronic condition or a specific problem, you may need other diagnostic visits or services during the year. It’s also important to treat problems right away, rather than waiting for a preventive health exam that may be months away.