At Gynecology Associates of North Georgia, we strongly agree with the American College of OBGYN recommendations for yearly preventive examinations.
Insurance companies have specific criteria as to what they will cover during an annual well woman exam.
Our billing office has had many calls from patients regarding their bills for charges incurred during a well woman exam that are not covered under routine well care.
We have created this information sheet to educate patients about what is routinely covered at the preventive annual well woman. When you come in for your next annual well woman exam, these are the things your provider will do.
These are all billed to your insurance company with a preventive well woman code:
- Measure weight and plot against your given height to calculate BMI
- Measure blood pressure, pulse and temperature
- Check heart, lungs, thyroid gland, abdomen
- Perform external genitalia exam
- Perform speculum examination of vagina and cervix
- Collection of pap smear, if indicated
- Pelvic examination of uterus, cervix and ovaries
- Discuss normal gynecologic functions of your body in accordance with your age
- Anticipatory guidance of future changes in your body
- Review your medical history, medications, allergies and offer advice as needed
- Review your social, family, sexual history and offer advice as needed
- Review your needs for contraception
- Refill medications
Other procedures such as ultrasounds, biopsies, injections, contraceptive insertions, pessary maintenance and laboratory blood draws are coded as such and may not be covered by your insurance under the well woman exam.
Other concerns that are more time involving and thought provoking such as stress and anxiety management, menopausal symptom management, abnormal bleeding, pelvic pain, breast mass, itching or yeast infections, bladder problems or other more involved issues will be coded with a separate code from the annual well woman code.
Due to this separate code, there is an additional visit charge. It is up to your insurance company and specifically your medical plan as to how they cover these charges. Some plans cover these charges completely, others require a separate co-pay (even when there is no co-pay for preventive care), and others do not cover these separate charges at all, considering it a “non-covered item”.
These billing issues are between you and your insurance company, and we always suggest you check with your insurer before coming to the doctor to know what is and is not covered by your plan.
Each plan has very different guidelines and we find coverage differs even within the same insurance company. Please make sure you are aware of your coverage in order to avoid unexpected out of pocket costs.