If you're lucky enough to have a clean bill of health, you're likely one of the many who makes an appearance at a primary care physician's office just once a year. The annual preventative physical exam comes with a lot of expectations, both on the part of the patient and the provider. Unfortunately, it's uncommon for those expectations to align.
Why the disconnect? First, we must define what the “yearly exam” means to a provider and your health insurance. Since the enactment of the Affordable Care Act, most health insurance plans are required to cover a preventative examination once per year without a copayment or the patient satisfying a deductible. When a patient schedules an “annual exam”, “preventative exam” or “physical”, providers are hoping to focus on preventative care and reducing health risks–but the patient often has a different agenda in mind.
Disagreement arises, though, when patients view this “free” examination as a time to bring up a list of concerns that have arisen or worsened since their last visit. They are often upset to learn that problems falling outside of the preventative measures are not included in their “free” appointment. To avoid confusion or frustration, it's important that all parties know what a preventative visit is and is not.
Understanding Everyone's Role
As primary care providers, we believe in the saying “an ounce of prevention is worth a pound of cure”, meaning we value that dedicated time to review overall health in an effort to keep you healthy or even identify problems in their early states. We also understand that your time is valuable and you have taken time out of your busy day to have a few minutes of our undivided attention. To ensure all parties are on the same page, brush up on the ins and outs of your once-a-year visit.
1. Preventative priorities: A preventative examination includes checking vital signs (height, weight, blood pressure, et cetera) and a complete physical examination to ensure there are no glaring red flags. During the visit, we also discuss age-appropriate cancer screenings, STD screening, nutrition and exercise recommendations, immunizations, birth control and family planning, heart disease and diabetes screenings, and depression screening. A full list of covered services for adults and children can be found here. As you can see, this is an extensive list to address in one visit, which is why some providers struggle to fit in conversations about other, more specific health concerns with patients.
2. Addressing existing concerns: If you have concerns to address that fall outside of the preventative visit, providers usually make the choice to address them at the present visit and reschedule the preventative examination. But remember, there is a limit to the amount of information that even a doctor can process and manage effectively in a short period of time. Think about being at work and your boss and co-workers all email you with tasks that need to be completed within the next 20 minutes. You could either attempt to complete them with minimal attention to each just to get it done, or you could say “I’m sorry, I really want to give these two items my full attention. I will get to these other items at a later time.” The same goes in healthcare. A preventative exam is generally allotted between 15 and 30 minutes depending on the practice, and that is inclusive of the time to check in, come back to a room, review medications and have vitals checked. The average time spent with a provider is approximately nine minutes. To make the most of this appointment time, look at your list and narrow down the top three concerns so your physician has the ability to address each with their full attention.
3. Understand billing to avoid sticker shock: Most physicians working in large healthcare systems are required to document and bill for separately addressed problems outside of the preventative “umbrella” of services. This means if you show up for your physical but have also been having knee pain and the provider has the time to address everything at the same visit, you should expect a separate bill for those services. Same goes if you score positive on that “covered” depression screening but after a discussion with your provider, get a referral to a therapist and start a new medication. I like the analogy of taking your car in for inspection: You expect to pay a fee for the inspection itself, but wouldn’t think to ask the mechanic to just “not bill” if they change your brakes, right? When dealing with healthcare services in the United States, it’s important to understand that these charges are not optional, nor are they at the discretion of the provider.
4. Consider another way: If this all sounds a bit ridiculous, you're right. We have a complicated, costly and generally ineffective healthcare model in the U.S. Many providers are just as frustrated with the current system, leading them to embrace a new model called Direct Primary Care, or DPC. This movement–driven by companies like PeopleOne Health–aims to renew trust in the doctor-patient relationship by allowing more time for appointments and reducing practice sizes to allow you to actually see your provider when you need or want to, all while reducing healthcare costs. DPC practices charge a fixed monthly or yearly subscription fee that ensures timely access to quality primary care. You can schedule as many appointments as necessary with your provider without worrying about copays or extra fees, which means you can have your preventative care physical and inquire about knee pains without the financial burden.
Removing insurance from the equation enables the provider to practice in the best interest of the patient. Companies like PeopleOne Health have taken this innovation a step further. Not only does PeopleOne Health ensure access to great PCPs, but for a cost similar to most DPC practices they also offer medications, laboratory services, imaging, nutrition, mental health services and access to telespecialty care among many other benefits. Improving access to PCPs means better healthcare utilization, reduced healthcare costs and better health outcomes for patients.
Sharing health concerns with your doctor is just as important as keeping up with preventative care, so be sure you're going into each appointment with the right intentions. In the end, you and your doctor are a team, and knowing what each person brings to the table is key in long-term health and prosperity.
About Dr. Melissa Rau Dr. Rau is a board-certified family medicine physician, which means she is trained to treat patients of all ages, from “cradle to grave” as they say. She is passionate about preventative care and keeping patients healthy before problems arise. She has been a part of the PeopleOne Health team since 2022.
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