Establishing care is the process of beginning a long-term relationship with a single primary care provider (PCP) that will be your trusted source for all your day-to-day medical needs. 
The first time you see your PCP, the appointment will be billed as “establishing care.”

This is NOT the same as a Wellness Physical Exam. An office visit is focused on treatment.
These visits are designed to discuss new or existing health issues, concerns, worries or symptoms,
and insurance companies usually require a co-pay.

For Example an office visit may be:

• An appointment to meet your new Provider and “Establish care” with them taking over current
medications and/or treatments that you were receiving from a different provider.

• An appointment to discuss specific, new or existing health problems, such as diabetes,
pain, medication adjustment and refills, chronic conditions, high blood pressure, etc.

Your provider may then prescribe medication, order additional tests like lab work or
X-rays, refer you to a specialist or discuss other treatment options.

Depending on your benefits, an office visit usually results in additional costs to you.

Based on the definitions above, you may be wondering if the same appointment can be
considered both a Wellness and an office visit?

The answer is, yes. However this can result in you receiving a bill. This is why it is very
important to know your insurance.

On occasion, one appointment can meet the requirements for both types of visits. If this is the case,
your provider will submit a charge for both a Wellness visit and an office visit. If your Wellness visit includes consultation or treatment for a specific condition, your provider is legally required to document additional medical services, and depending on your insurance may result in additional charges that are not fully covered.

So, what does this mean for you?

While combining a preventive visit and an office visit will save you time by eliminating an extra
appointment, it may also affect your costs. Providers must bill your visit based on both the
reason you initially scheduled the appointment and what is done during the appointment. It’s
important to remember that when you see your provider for a physical, something more than a
general evaluation may result in unplanned out-of-pocket costs for you based on your benefit
plan.

What is a Wellness Exam about?

Your annual visit is the perfect opportunity to be candid with your PCP about your health.
Keep in mind, while the Affordable Care Act ensures annual wellness visits are provided at no cost, there could be a fee if you ask to discuss any particular concerns that are not considered part of a basic Wellness exam — so make sure to ask your PCP at the start of your visit what you may talk about, so your wellness visit stays free.

You can always make a follow-up appointment to address other issues.

A Wellness visit is a yearly appointment intended to prevent illnesses and detect health concerns
early, before symptoms are noticeable. Depending on your specific insurance plan, this type of
visit may be called an annual physical, well-child exam, Medicare wellness exam or welcome to
Medicare visit. In terms of cost, insurance companies generally cover preventive care services at
no cost to patients.

The purpose of a preventive visit appointment is to review your overall health and well-being.

Depending on your age, services may include:
• Complete physical exam
• Blood pressure, blood glucose and cholesterol screening tests
• Pelvic exams, pap smear
• Prostate and colorectal cancer screenings
• Sexually-transmitted disease testing
• A thorough review of your general health and well-being
• Immunization review and update
• Developmental screenings

Wellness visits are an opportunity to discuss care areas and share lifestyle modifications to
establish a long-term health plan.