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Preventive Visits vs. Office Visits: What to Know

05/01/17

Have you ever questioned why you should see a doctor for a preventive visit when you feel perfectly healthy, and how that appointment differs from a regular office visit?

Preventive Visits

Preventive visits typically are annual visits or well-child exam visits to your primary care physician (PCP) that are prevention-focused. The purpose of these visits is to detect health concerns prior to developing noticeable symptoms, hopefully preventing extreme illness.

Health insurance companies cover these types of services at no cost to the member, helping their members live healthier lives.

Preventive visits may include:

  • A complete physical exam
  • Screenings, assessments and counseling
    • Blood pressure, blood glucose, cholesterol
    • Pelvic exams and Pap smears
    • Prostate and colorectal cancer screenings
    • Sexually transmitted disease tests
    • Alcohol, tobacco, depression and obesity counseling
  • Certain immunizations

Even if you're feeling healthy, preventive visits are important as they create a baseline for your health for your PCP, allowing any problems to be detected early.

Office Visits

Office visits are appointments you schedule with your doctor that focus on existing conditions or new symptoms you might be having.

For example, if you have a cold that has lasted for a prolonged period of time and you make an appointment to see your PCP, that appointment would be an office visit. Your PCP or one of their colleagues will examine your symptoms and may prescribe medication, order tests or refer you to a specialist, related to that cold.

These visits are typically covered by your standard insurance copays or deductibles.

Know the Difference, Avoid the Confusion

It's easy to see where the confusion might set in. If you have a preventive visit scheduled, it's logical to address a specific concern at that visit, saving time and eliminating an extra appointment.

Be aware that addressing a specific concern may change the billing from a preventive visit to an office visit for some treatments and you may be responsible for that cost. Regardless of the appointment, it's important to always discuss health concerns with your PCP and to schedule regular preventive visits.

If you have questions about your coverage, contact Member Services via MyChart or by emailing ppicinfo@pplusic.com.