Information for our Patients Regarding Annual Well Woman Exams
Our office makes every effort to follow the current coding practices for reporting medical services as dictated by Federal law and, the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). These regulations can be quite complicated and generate many questions from our patients. The purpose of this document is to clear up any confusion caused by these complicated rules regarding the billing of Preventative and Screening services.
The Well Woman or Preventative exam charges for our practice include:
- A complete history and examination in addition to a breast and pelvic exam. There will be questions about other medical conditions and counseling on risk factors such as sexually transmitted diseases, diet and exercise, stress management, smoking cessation, self-breast exams, birth control, and menopausal issues.
- The collection/preparation of your Pap smear and Human Papillomavirus (HPV) specimens to the laboratory is included. HPV testing is an ACOG recommendation for women over 30 years of age. If you fall in this category, our physicians may do an HPV screen as part of your annual exam. This will be filed as part of your preventative visit. This may or may not be a covered benefit under your plan. It is your responsibility to inform the physician if you do not want this test done at the time of service. If both tests come back with normal results, then the tests do not need to be repeated for up to 3 to 5 years.
- Appropriate laboratory and diagnostic tests, such as a mammogram and DEXA, may be ordered and will be billed by those entities.
- Ultrasounds done during a preventative visit are generally a covered benefit by most insurance companies. Immunization administration and other procedures are not considered preventative by most insurance companies.
- Testing for gonorrhea and Chlamydia, if indicated.
Our doctors cannot comply with any requests to alter the medical records for the purpose of obtaining payment by billing for a medical visit when no other major problems were evaluated. If you are experiencing a major problem, our physicians will determine if you should reschedule your annual exam at a later date or if a follow-up medical visit is needed.
We are not responsible if your insurance carrier does not pay for the entire office visit. If you have questions regarding your medical coverage, we recommend you contact your insurance company.
Our office staff will be happy to assist you with any questions. Providing you with high-quality healthcare remains our first priority.
We thank you for choosing us to assist you with your healthcare needs.
