Preventive Visits (Physicals) and what it means for you!

The Good news about Preventive Visits/Physical/Well-Visits!

Have you heard the good news- “Preventive Visits” are 100% free to you! That sounds like great news doesn’t it?  It is, but it’s very important to know what “preventive” means so you can take full advantage of the opportunity.  The easiest way to determine what is a preventive visit (versus diagnostic) is to think of it as an information gathering visit to determine what your current state of health and well-being is and how it corresponds to other people of your age and gender. It’s best to do it when you are feeling well (thus the common moniker “well-visit”), you don’t have any current or new health concerns to discuss during the visit (thus no change in medication, no new prescriptions are given, no normal screening labs are ordered),  and /or no follow-up for a health issue discussed during the visit is scheduled.   For example, during your Physical/Preventive/Well-Visit, your doctor may notice that you are at risk for diabetes and have not been tested.  Your doctor then decides to test you. That screening/testing is part of your preventive visit.  However, if you are diabetic and you are at your Physical/Preventive/Well-visit and you are having complications due to your diabetes that are addressed by your doctor, that preventive/physical visit is now two visits: A physical/preventive visit and a diagnostic care visit where you will be responsible to pay a co-pay/co-insurance or deductible.   The same also applies if you are coming to your doctor and the doctor performs a routine screening related to the visit that may have been covered as preventive if you had come in for a preventive visit.  The screen is part of your diagnostic care and as such you will be responsible for the co-pay/co-insurance deductible for that visit.   So regular preventive care can help you stay well, catch problems early on, save you money and may be potentially life-saving.

So what can you expect during a Preventive/Physical/Well-Visit?

The rules for what is considered a preventive visit or part of a preventive visit and what isn’t are set by the Center for Medicare and Medicaid Services and your Health Insurance company.   As your health care provider, we are required to submit accurate health records indicating the exact reason for your visit and everything that was done and discussed during your visit. Each concern is grouped into a visit code and a diagnostic code.  That is how the different topics and health concerns addressed at your visit are organized into “preventive” versus “diagnostic” care.   Any attempt to not accurately account for everything puts you at risk and undermines our ethical obligations.  With that said, there isn’t a set rule as to how a Physical is conducted. Each doctor or practice will develop its own method of gathering necessary information (basically the purpose of a Physical) to see what is your current state of health and well-being.

Generally you can expect all, some or a variation of the following (courtesy of WebMD):

History: This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about important behaviors, like smoking, excessive alcohol use, sexual health, diet, and exercise.  The doctor will also check on your vaccination status and update your personal and family medical history.

Vital Signs: These are some vital signs checked by your doctor:

·         Blood pressure: less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.

·         Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.

·         Respiration rate: Around 16 is normal. Breathing more than 20 times per minute can suggest heart or lung problems.

·         Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.

General Appearance: Your doctor gathers a large amount of information about you and your health just by watching and talking to you. How is your memory and mental quickness? Does your skin appear healthy? Can you easily stand and walk?

Heart Exam: Listening to your heart with a stethoscope, a doctor might detect an irregular heartbeat, a heart murmur, or other clues to heart disease.

Lung Exam: Using a stethoscope, a doctor listens for crackles, wheezes, or decreased breath sounds. These and other sounds are clues to the presence of heart or lung disease.

Head and Neck Exam: Opening up and saying "ah" shows off your throat and tonsils. The quality of your teeth and gums also provides information about your overall health. Ears, nose, sinuses, eyes, lymph nodes, thyroid, and carotid arteries are also examined.

Abdominal Exam: Your doctor can use a range of examination techniques including tapping your abdomen to detect liver size and presence of abdominal fluid, listening for bowel sounds with a stethoscope, and palpating for tenderness.

Neurological Exam: Nerves, muscle strength, reflexes, balance, and mental state are assessed.

Dermatological Exam: Skin and nail findings could indicate a dermatological problem or disease somewhere else in the body.

Extremities Exam: Your doctor will look for physical and sensory changes. Pulses can be checked in your arms and legs. Examining joints can assess for abnormalities.

Male Physical Exam

An annual physical exam for men might also include:

• Testicular exam: A doctor can check each testicle for lumps, tenderness, or changes in size. Most men with testicular cancer notice a growth before seeing a doctor.
•  Hernia exam: The famous "turn your head and cough" checks for a weakness in the abdominal wall between the intestines and scrotum.\
•  Penis exam: A doctor might notice evidence of sexually transmitted infections such as warts or ulcers on the penis.
•  Prostate exam: Inserting a finger in the rectum lets a doctor feel the prostate for its size and any suspicious areas.

Female Physical Exam

A woman's annual exam might include:

• Breast exam. Feeling for abnormal lumps may detect breast cancer or benign breast conditions. The doctor will also check the lymph nodes in the underarm area and look for visual abnormalities of the breasts.
• Pelvic exam: The pelvic exam allows examination of the vulva, vagina, and cervix. Routine checks for sexually transmitted infections are often done. A Pap test can screen for cervical cancer. 

Laboratory Tests

There are no standard laboratory tests during an annual physical. However, some doctors will order certain tests routinely:

• Complete blood count
• Chemistry panel
• Urinalysis (UA)

Unless symptoms already suggest a problem, these tests are unlikely to provide useful information.

A lipid panel (cholesterol test) is recommended every five years. Abnormal cholesterol levels increase the risk for heart attacksand strokes.

Physicals Should Emphasize Prevention

• At age 50, it's time to begin regular screening for colorectal cancer. People with immediate family members with colorectal cancer may need to be screened before age 50.
• For most women, age 40 marks the time to begin annual mammogram screening for breast cancer.
• Everyone should have their cholesterol (lipids) checked every five years after age 20, according to the American Heart Association.

When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  Make the appointment when you truly are well so the visit can focus on verifying your health and helping you manage your good health.  Check with your insurance company which other services are considered “preventive” and thus have no co-pay/co-insurance or deductible.  For example, most insurance companies are now fully covering a variety of immunizations such as: Hepatitis A and B, Flu, Herpes Zoster, Pneumococcal and more.  All you have to do is come in specifically for and only for a covered vaccination and it’s totally free to you (your health insurance will be billed and your health insurance carrier will cover your co-pay, co-insurance and any deductible).  The best way for you to know which services your plan considers “preventive” and free to you is to call your insurance company and ask. Visit avecinia’s list of  health insurance companies it is contracted with to find your insurance company’s website/contact information.  Generally, the preventive services listed under the Affordable Care Act will be covered services.  Take advantage of this great opportunity to save money and save your life today!

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Health Care, Wellness and the Affordable Care Act of 2010

As the valley’s premier Integrative Medicine and Wellness center, avecinia wellness center is committed to your care and well-being.  As such, we are committed to helping empower you so you can make the best choices when it comes to your healthcare and well-being.  Your choice in health insurance should never effect your decisions about improving your health and well-being.  However, since the cost of health insurance is an important factor, it is vital for you to be well informed so you can make the best choice for you and/or your family. We hope the following information helps guide you towards better health and well-being.

In March of 2010, the President signed into law the hotly debated Affordable Care Act.  Whether you agree with the act or not, it is now the law and many of its provisions and benefits kicked in September 23^rd.  But they only apply to new plans, or plans that begin on or after September 23, 2010.   Here is a summary of these benefits, benefits to come and how they affect you (we categorize them by who they affect).  As always recommended, call your insurance provider, employee benefits manager, or a licensed Health Insurance Broker if you have questions about your plan.

For everyone:

•   Preventive Care
• Plans starting on or after September 23, 2010 will cover all your costs for a Preventive Care visit.  That means you do not have to pay a copayment, co-insurance or any deductible for preventive health services such as recommend screenings, vaccinations and counseling.  Keep in mind that coverage is only for in-network providers, and is only applicable if the preventive service is the primary purpose of the visit.  If the preventive service is in addition to other services, your plan may require to pay for the visit. If you have questions, please call your health insurance provider to verify which services are considered preventive and are free to you (i.e., you have no copay, co-insurance or deductible).  When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  If you need to discuss any service or health issue outside what your health insurance plan covers as a preventive service, your provider has to submit that information to the health insurance plan and you may be billed for the visit because it is no longer considered a preventive visit.   
• An End to Pre-Existing Conditions for Children
•  Health Insurers cannot deny children (under 19 years old) health insurance because of preexisting conditions. A ban on adult discrimination will take effect in 2014.  That means if your plan went into effect after September 23, 2010 and in November your child is hospitalized because of a severe asthma attack.  Your new plan cannot deny payment for the hospitalization due to your child’s “pre-existing condition.”  Keep in mind that insurance companies are now reducing the number of children only plans. When looking for an insurance plan, make sure it covers your kids!
•  Coverage for young adults under the age of 26
• Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance plan until they turn 26.  This applies to your kids even if they are married or can get insurance from their employers group plan.  Your child does not have to be living with you or be financially dependent on you.   Keep in mind that you must enroll your children within the open enrollment period. 
• Doctor Choice & ER Access
• The Act helps preserves your choice of primary care physician within your health insurance plans network.  It also prohibits health insurance plans from requiring a referral before you can see a OB-GYN in your network.  Importantly, the Act prevents health insurance plans from requiring higher copayments or co-insurance for out-of-network emergency room services and it prohibits plans from requiring prior approval before seeking emergency room services from a provider or hospital outside of your plan’s network. Keep in mind that you will still be responsible for the difference between the amount billed by the out of network provider and the amount paid by your health insurance plan.
•   Insurance Cancellation
• Health Insurers cannot retroactively rescind (declare your policy invalid from the date you started your policy) your insurance policy for an honest mistake or missing information that has no bearing on your health.  That means if your plan went into effect after September 23, 2010 and you are later diagnosed with cancer, your health insurance provider cannot rescind your plan because you left out your hospitalization for a broken arm 6 years ago. Keep in mind that intentionally falsifying or misleading the insurance company still gives them cause to rescind your policy.  Your health insurance provider has to give you 30 days notice before it can rescind your policy so you can appeal the decision or find new coverage.
• Appealing Health Plan Decisions
• You now have the right to appeal your health insurance providers denial of payment, service or treatment.  If your plan upholds its denial, you have the right to ask for an independent review.  Keep in mind that your state may have additional rules/regulations that effect your appeal.  For more information in California, click here.
• Lifetime and Annual Limits
•  Lifetime limits on most benefits are prohibited on plans issued or renewed after September 23, 2010.  Annual Limit are being phased out as well.  No plan that begins after September 23, 2010 can set an annual limit lower than $750,000.  By January 1, 2014, no annual limits will be allowed on most covered benefits. Keep in mind that the ban on limits only applies to essential services.  Some plans may be eligible for a waiver if complying with the ban on the limit would mean a significant decrease in benefits or increase in premiums.

For Medicare:

• Preventive Care
• Medicare must now pay for 100 percent of the cost of annual physicals and other preventive care visits (see above for more information).
•  Seniors Receive “Donut Hole” Rebate
•  Seniors with Medicare prescription drug coverage that have reached their coverage gap in 2010 will get a 1 time tax free $250 rebate. Beginning in 2011, Medicare recipients will receive 50% off of covered brand-name drugs while in the “donut hole.”
•  Stronger Medicare Anti-Fraud provisions
• Visit www.stopmedicarefraud.gov to see how you can help curtail Medicare fraud.

For Businesses:

•  Small business tax credit for providing health insurance
• Small business with less than 25 employees may be eligible for a tax credit of up to 35% to offset the cost of providing health insurance to their employees.  If you are a small business owner, check with your accountant to see if you qualify or how you can qualify.
• Wellness Program Grants for Small Business
•  Small business with less than 100 employees may be eligible for grants to cover Wellness Programs that started after March 23, 2010.  Grants will be available in 2011.
• Early Retirement Reinsurance Program
• The Act provides $5 billion in financial assistance to employers and unions to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.

To learn more about the provisions of the Affordable Care Act, visit www.healthcare.gov.  To learn more about Medicare, visit www.n4a.org.  
This video is a helpful summary

Choosing an Health Insurance Plan

If you are purchasing a health insurance plan on your own or your employer gives you the option to select from a variety of health insurance plans, visit the California Department of Insurance PPO Ratings to learn which plans had the best rankings. According to the Department of Insurance, Aetna PPO, CIGNA PPO and Health Net of California PPO rated the highest as rated by their members across a variety of standards.  As a practice, we have noticed that Aetna, CIGNA, and United Healthcare provide coverage for a wide range of services, have less administrative burdens, and are more consumer friendly and oriented than other health insurance companies.  You can also contact a licensed Insurance Broker who will help guide you through the insurance maze and help you find the plan that best fits your needs.  A broker will do this for you for free because they get a commission from the insurance company.  Overall, insurance companies pay the same amount of commission so a licensed broker should not be swayed towards one policy or another but should help you find the solution that is best for you.  If you are looking for a broker or have questions in general, contact Shane Moore at Valley Employee Benefits & Insurance Solutions.  He can be reached at (559) 325-2500 or by email at shane@valleyemployeebenefits.com.  If you have other questions, please call or email avecinia wellness center’s insurance specialist, Colette Vaquilar at (559) 450-7298 or billing@avecinia.com. Visit www.avecinia.com and "like" us at www.facebook.com/avecinia




For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!