Not all health care visits are created equal. In fact, understanding the different types can improve the convenience and overall cost of your care.
Time: Your provider’s office needs to know what your goals are for each visit to schedule the appropriate amount of time. Choosing the right level of care can also save you time.
Cost: Knowing what your insurance covers prevents billing surprises, and choosing the right kind of visit – emergency room versus an office visit – can save you out-of-pocket expenses.
Primary Care Visits
Your primary care provider is the person you see for your overall health and minor issues as they arise.
At a Primary Care Visit, the provider addresses a specific problem – a cough, rash or other symptom -- that may be new (acute) or chronic. This visit includes a review of your symptoms, an exam and the provider's recommendations.
Cost: Some insurance plans charge a copay for this type of visit. Others require you to pay the full cost of all visits until you reach your deductible.
Tip: Some health systems offer additional ways to conveniently receive minor medical attention, such as virtual care. Check your options to determine which is best for you.
Preventive Care Visits
An annual physical might seem like just another office visit to you, but it’s actually scheduled and billed differently.
At a Preventive Visit/Annual Physical, the provider evaluates your overall condition. These yearly visits are intended to keep you healthy and include counseling, education and the provider's recommendations for appropriate next steps, including cancer screenings or lab tests.
Cost: Deductible plans cover most preventive care services at little or no cost, other than the co-payment or co-insurance for the office visit. That is, the preventive care is free, but the office visit is not.
Tip: If you discuss symptoms of acute or chronic diseases at your Preventive Visit/Annual Physical, it is considered "diagnostic" and you will likely be required to pay a co-payment. If you want to address more than one issue during your visit, tell the office staff first so appointments can be scheduled appropriately.
School/Sports Physical Visits
Parents often ask why they have to schedule a separate office visit for a school or sports physical. These typically require a specific review of your medical history and a physical exam completed on a special form. Sometimes the required history questions and physical exam are beyond what’s normally done during an annual physical.
Cost: A school/sports physical is generally not covered by insurance unless it can be completed as part of an annual physical.
Hint: CHI St. Alexius Health offers $50 sports physicals if you prefer to not use your insurance. Simply call the Occupational Health Clinic at 701.774.7077.
Specialty Care Visits
Sometimes you need care beyond what your primary care provider offers, such as for diabetes complications or a heart condition. A specialty provider – or specialist – addresses particular types of illness or specific parts of your body.
Cost: Plans with co-pays often charge a slightly higher fee when you see a specialist. Some plans (HMOs and EPOs) require a referral from your primary care provider before seeing a specialist, even if the specialist is in your network. Other plans treat specialist visits the same as primary care visits.
Some plans offer limited coverage for other types of specialists, such as:
- Chiropractors
- Physical therapists
- Registered dietitians
- Alternative and complementary practitioners such as acupuncturists
Tip: Check how many visits are allowed by your plan and how much the plan will pay.
Understanding which office visit is right for you can help you save time and money. You may also find that these simple tips will give you a refreshed piece of mind when navigating today’s health care environment.