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Preventive vs. Diagnostic Care

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Preventive vs. Diagnostic Care
Scroll to learn more

Preventive vs. Diagnostic Care

What’s the difference and can I be charged for both in the same visit? At first glance, a physical and an office visit may seem like the same thing. It’s important to understand the differences between the two, because it may affect your costs.

Preventive Care Visit (or Physical)

Diagnostic or Office Visit

Your plan covers 100% of these services with in-network providers.

You may be charged for these services depending on your benefits.
Routine health care that is focused on preventing illnesses, disease or other health problems.  It could include:

  • A review of your general health and well-being
  • Physical exam
  • Check-ups
  • Screenings
  • Immunizations
  • Counseling and interventions
  • Recommendations about general health like diet, exercise, disease screenings or well-being

Preventive care depends on your age and other risk factors.

Health care appointment that is focused on existing health concerns:

  • Discussion of a concern, condition or injury and your treatment options
  • Lab work, X-rays or additional tests
  • Prescription medication to treat the problem

Can one appointment be considered both?

Based on the definitions above, you may be wondering if the same appointment can be considered both a physical and an office visit? The answer is, yes.

What does that mean for you?

While combining a preventive physical and an office visit will save you time by eliminating an extra appointment, it may also affect your costs. On occasion, one appointment can meet the requirements for both types of visits. Providers legally must bill your visit based on both the reason you initially scheduled the appointment and what is done during the appointment.

For this reason, it’s important to understand your benefit information and what costs you can anticipate.

Physical or Preventive Care FAQs

Physicals or Preventive Care are appointments focused on preventive health screenings and general health. At these visits, the provider performs a physical exam and reviews the preventive screening recommendations for your age. Other health topics can be addressed as time allows, though additional copays may apply.

How often you should come in depends on your age and other risk factors, such as personal and family health history. You will need to discuss this with your Primary Care Provider to determine a regular preventive health visit schedule that is tailored to your health and well-being.

The table below provides the general recommendations for how often most patients should have a physical:

 

Age General Advice on How Often Age Group Should Have a Physical
Less than 2 years old 2, 4, 6, 9, 12, 15, 18, 24 and 30 months
3-21 years old Once per year
21-44 years old Every three years. Depending on your health history, your provider might recommend more frequent visits.
45-54 years old Every two years. Depending on your health history, your provider might recommend more frequent visits.
55-64 years old Every year.
65 years old and older Every year.*

*Medicare Plan B insurance only covers Medicare Annual Wellness Visits, not physicals. 

To protect access in our schedules for urgent and chronic disease care, patients should expect that it might take three to six months to schedule a physical appointment with some providers, so it is best to plan ahead!

We recommend that teenagers have preventive exams every year. However, the WIAA requires a sports card be filled out every two years, after March 1st. For physicals that require a sports card, we recommend scheduling these appointments six months in advance.

For ages six and older, a video visit may be an option for preventive care visits. However, you may still need to come in for necessary vaccinations, laboratory collections and focused examinations.

GHCMyChartSM messaging is not meant to be a same-day service. Response times cannot be guaranteed, but most messages are read and replied to within five business days.

For questions that require a same-day response, we recommend you call your clinic to speak to someone on your care team.

Please visit our Contact page that includes the phone numbers of our clinics.

Typically prescription refills will be handled within three business days of the request.

  • A non-urgent phone call with provider input will receive a response in three to five business days.
  • Medically urgent issues will be addressed the same or next day, depending on when the call is received.
  • Non-urgent lab results will be interpreted by the provider within three business days of the past results.
  • Urgent lab results will be interpreted by the provider on the same or next day.
  • Form completion is within five business days.
  • Complicated forms may require an appointment.
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Understanding Your Benefits

If want to learn more about your insurance coverage and costs, review your Summary of Benefits and Coverage. You can also call our Member Services team Monday through Friday, 8 a.m. – 5 p.m. at (608) 828-4853.

Summary of Benefits and Coverage