Dear Valued Patient,
Annual wellness exams are an excellent way to take a proactive approach to your health care. In many cases, your insurance company may support these visits by waiving copays and laboratory charges for certain preventive services.
Thank you for choosing our practice for your preventative health needs and we are happy to address any other medical concerns you may have. Please be aware that if you are seen for preventive care and your provider assesses and treats any concerns or problems during the wellness exam, it is considered a problem-focused exam. Rather than schedule a second visit for a later day, for your convenience, we may address all your concerns while you are already in the office for your wellness visit if you would like to focus only on preventive care today. we can help schedule another visit with your provider to address other concerns.
If your visit is both for annual wellness concerns and problem-focused concerns, your insurance may process your visit as two separate office visits. Both the annual wellness exam and the problem-focused exam will be reflected in your explanation of the benefits statement from your insurance company. As a result, you may be subject to a copay, co-insurance, or deductible for the problem-focused portion of your visit.
Each patient is responsible for verifying any payable benefits for wellness visits and coverage of other conditions with their individual insurance carrier on the date of service. Our office enters the insurance claim based on the entirety of services and tests done during your visit. MedOneMedical Group cannot guarantee coverage of your insurance claim or any specific insurance payment amounts.
I have read and understand the above information. fi my insurance plan considers today's visit two separate exams and requires additional out-of-pocket expense. I understand that it is my responsibility to pay
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FAMILY MEDICAL HISTORY
MGM= maternal grandmother, MGF= maternal grandfather, PGM= paternal grandmother, PGF= paternal grandfather