What is a Complete Physical Exam, and what does it include?
There is a huge difference between what physicians and patients believe a complete physical exam (CPE) constitutes and what insurance plans advertise as an “annual physical,” “wellness exam,” or "preventative maintenance exam". I believe that a CPE is an annual opportunity for you to spend an entire 45 minutes with me to discuss any medical issues you have, and it allows me a chance to review all of your medical problems— even ones that you may feel are stable. New treatments may have developed over the preceding year or new guidelines may have been issued that might help. I can take the time to perform a full physical examination, and it gives me a chance to review all types of preventative measures such as cancer screening, vaccinations, and other important health services.
Insurance companies’s view of physicals vary widely. They only consider an annual physical as a visit where you have no medical issues to discuss, and a physician simply performs an examination of you and reviews preventative health measures and vaccinations. If your insurance plan offers an "annual physical without any co-pay" this is all that they cover.
If I were to review your medical problems to make sure you were being adequately managed, the insurance plan would consider that visit a "sick visit." If you wanted to ask about any other medical issues, your insurance plan would also call that a "sick visit." In other words, your insurance plan wants you to schedule separate visits for your "annual physical" and your "sick visits" to cover what you and I feel should be covered in your true complete physical exam.
So to prevent you from having to schedule two separate visits to cover what I feel should all be covered in a CPE, I combine both visits into one. However, this means that we will be submitting claims to your insurance plan for both a CPE and a "sick visit" when you schedule your annual physical with me. This also means that even if your annual physical is covered without a co-pay, you will still have a co-pay (and any possible deductible) for the “sick visit” portion of your visit.
Incidentally, this is how our physicals have been coded for over 10 years, so if you’ve never had an issue with your physicals before, you will notice no changes whatsoever.
Physical exams usually include basic screening lab tests, although what is covered can vary by the insurance company. If certain labs are covered as part of your annual exam as long as a certain code is used, it is your responsibility to find out about that and let us know. Otherwise, we will code what is medically appropriate. This only becomes an issue if your insurance company charges a co-pay for yours labs, but not if labs are part of the physical. We need to know that before ordering your test because it is difficult to change the codes after they have been billed.
Additional testing such as x-rays or treadmill tests are rarely included in your routine annual exam and are usually only performed in appropriate clinical situations. Medical research has shown that routine x-rays such as chest x-rays have not been proven to help prevent death from cancer, and that treadmill tests in people without symptoms or suggestive findings have not been shown to effectively predict heart attacks.