Is my Wellness/Physical covered by my insurance?
Most insurance plans that are approved by the Affordable Care Act cover a Wellness Visit/Physical Exam every 12 months. These visits and labs are typically covered by insurance with no out-of-pocket cost for patients. Certain health plans may be ‘grandfathered in’, and not be in compliance with the Affordable Care Act. You can call your insurance plan and ask if wellness visits are covered with no out of pocket to you every twelve months. Manhattan Primary Care will use the ICD-10 diagnosis code Z00.00.
Will labs be covered at no out-of-pocket expense?
You can check with your insurance carrier by asking: “Are the following lab tests covered at no out of pocket cost to me if billed with corresponding ICD – 10 code: CBC (CPT Code 85025, ICD-10 Code Z00.00); Complete Metabolic Panel (CPT Code 80053, ICD-10 Code Z13.1), Lipid Panel (CPT Code 80061, ICD-10 Code Z13.220); and Thyroid Stimulating Hormone (TSH) (CPT Code 84443, ICD-10 Code Z13.29)?”
What is included in a physical?
Physicals include a review of the entire history, review of wellness measures such as vaccines, colonoscopy, exercise, nutrition, weight management, blood pressure check, and review other lab screening recommendations such as HIV testing or Hepatitis C screening. You and your medical provider will discuss pap smear, breast exam, mammogram and birth control options with female patients. Prostate cancer screening and men’s health screenings will be discussed with male patients.
What is not covered at a physical?
Acute problems such as injury, low back pain, or sinus infection are not covered by insurance on the same day as a physical. Chronic medical problems such as changes to your blood pressure medication, diabetes, or other chronic problems are not covered by insurance during the same day as a physical. If these health concerns are more pressing, we may discuss those during the visit and reschedule the physical to a later day. This is done to prevent unexpected out of pocket costs to our patients, due to insurance not paying for the additional problems discussed.
What if I want to get my physical or physical labs early?
Insurance may deny coverage for your physical or labs and you would be responsible for the entire bill if you get your physical done early. That is why we stress to get the labs done in the same month as your physical. MPC can advise when you last physical was with us and schedule your updated physical 12 months later. If you are transferring care and are unsure when your last physical occurred, call your insurance or your last primary care physician to see when you can get your labs and your physical.
Where can I have my lab draw performed?
Choices for lab draws include Excel Clinical Lab, Labcorp, Quest, and Via Christi Hospital.
Excel Clinical Lab: 1133 College Ave, Building A Suite 145, Manhattan, KS
LabCorp: 1133 College Ave, Building E Suite 250, Manhattan, KS
Quest Diagnostics: 1419 Wesport Landing Place, Suite 107, Manhattan, KS
Via Christi Hospital: 1823 College Ave, Manhattan, KS.
When should I get my labs done?
It is not required, but recommended to get labs done at least 2 days prior to your physical. This is so the results are back prior to your appointment.