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What You Pay for Annual Preventive Care Exams

January 2020

Annual preventive care exams—they’re an important part of preventing certain diseases and staying healthy. So each year, you make an appointment for one with your doctor.

But what happens when a month later you receive a bill? Aren’t annual preventive care exams free as part of preventive care coverage under your UC PPO plan?

Here’s what to keep in mind before your next annual preventive care visit.

Preventive Care Exams (Annual Physicals) Are Covered Once a Year

You can receive a preventive care exam at no cost once each calendar year. You don’t need to wait 12 months from your previous exam. For example, you could receive a preventive care exam in September of 2020 and then again in May of 2021.

Existing Health Conditions

This is tricky. During your preventive care visit and exam, you want to talk with your provider about everything that’s happening with your health. However, if you receive treatment for an existing medical issue or chronic condition, your preventive care visit becomes a “physician/specialist office visit.” That’s because part of your visit was preventive care and part of the visit was treatment for a specific medical issue or chronic problem. If this happens, you may be billed your applicable copayment or coinsurance for any services not covered as a preventive service.

To avoid being billed for your preventive care visit, you may need to make a separate appointment to discuss or ask questions about an existing health condition or issue.

Get the Facts

During your visit, talk to your provider about the services you’ll receive, so that you know what may not be covered under preventive care. You have several resources to help you prepare:

  • Anthem Blue Cross preventive care guidelines for more information on covered preventive screenings and immunizations.
  • UC PPO plan's coverage for a summary of your cost for services beyond preventive care. You can also review your plan’s Benefit Booklet.
  • An Anthem Health Guide to understand what’s covered under your free annual preventive care benefit and what might trigger an extra cost to you. They can also help you understand any bills you receive after your visit. Call Anthem Health Guide toll-free at (844) 437-0486 before your next visit.