Preventive care is critical to your overall health. From your annual wellness exam to routine immunizations and screenings, preventive care helps identify potential health problems and preventable issues early on so you can take action to keep them from becoming serious or chronic conditions.

Receiving preventive care is quick and painless. And most often, it’s covered at 100% by your health plan—meaning you don’t have to pay a deductible, coinsurance, copayment or have an annual limit. At HFM, we want you to be your healthiest self and live your best life. That’s why we do everything possible to make your preventive care as quick and convenient as possible—from scheduling appointments online to receiving test and screening results directly in your Froedtert & MCW MyChart account. And don’t worry—if you don’t know what preventive care you might need, we can provide recommendations based on your age, gender and family history.

The Difference Between A Preventive Office Visit and a Problem Office Visit 

We’re committed to empowering you to take control of your health care. A topic that comes up most often is what is the difference between a prevention-focused versus a problem-focused office visit and what types of care are considered preventive. Here are a few questions and answers we hope will help you with this topic.

What exactly is “preventive care,” and how is it covered by insurance?

Simply put, preventive care is prevention-focused health care provided to prevent illnesses and detect health issues early before they become problems—oftentimes before you even notice any symptoms.

What is Considered Preventive Care?

  • Annual preventive exams, well-child exams and routine screenings like colonoscopies and mammograms
  • “Welcome to Medicare” exams — annual preventive physicals in the first year you start Medicare
  • Medicare Annual Wellness Visits (AWV) — done by an RN prior to your annual preventive physical with your primary care provider

Most health insurance plans are required to cover preventive care at no cost to you when you use an in-network provider—that means no copay, no deductible. The charges are covered at 100%, as long as you use a provider that participates in your insurance plan’s network.

What is An Annual Preventive Exam and What Does It Include?

When you visit us for your annual preventive exam, you’ll receive a complete exam designed to review your overall health and well-being, as well as a review of your medical history and any medications you take. Along with these services, you’ll also receive any age-specific immunizations and screenings including blood pressure screenings, colorectal screenings, pap tests and prostate exams. Your annual preventive exam does not include any services related to addressing an illness or injury you bring up during your visit.

If It’s Not Preventive Care, What is It?

As soon as a health problem is discussed in your annual exam or other preventive care visit—whether it’s a chronic illness or injury or something that just came up—the health care becomes problem-focused. When that switch occurs, you can be billed for anything related to the problem-focused part of your visit. Copayments and deductible amounts apply.

Unexpected Health Care Bill? What to Do to Avoid Being Caught Off-Guard

Follow these simple steps to ensure you’re receiving the cost-free, preventive care you expect:

  1. When scheduling your appointment with us, double-check that we’re an in-network provider, and make sure you specifically tell our office you’re requesting “preventive care only,” like your annual preventive physical
  2. When you come in for your appointment, remind your provider you’re there for preventive care only
  3. If you bring up additional problems different from what’s discussed specifically for the purpose of your preventive care visit—like the flu or a rash—and wish to have those treated in the same visit, they will be processed separately as a problem-focused visit. If you wish to combine a preventive and problem-focused office visit in one appointment, please let us know upfront when scheduling your appointment.

Check out the chart below to see which health care services fall under preventive care, and which are considered problem-focused. And remember:

  • Preventive care means the service is covered at 100% when using an in-network provider—no copay or deductible
  • Problem-focused services are subject to your insurance plan’s copayments and deductibles, and not considered preventive care

You’ll see one listing in the chart that could be either preventive or problem-focused. To learn how that service would be covered for your specific circumstance, or if you have any questions on how other care not listed would be covered, call us at 920-320-2436.

Service Preventive Problem
Age-appropriate screenings, like a bone mineral density test, colonoscopy or mammogram  
Annual preventive exam  
General screening blood work or lab tests that indicate overall health  
Medicare Annual Wellness Visit (AWV) or “Welcome to Medicare” exam  
Personalized prevention plans, for issues like depression, obesity and tobacco  
Review of your health factors to evaluate risk of future problems  
Age-specific vaccinations/immunizations  
Well-child exam  
Management of stable, chronic conditions—like diabetes or heart disease—to improve your quality of life, including refilling medications  
Medication review
New treatment plan for chronic problems—like diabetes or heart disease—that may include new prescriptions  
Addressing acute health issues that require immediate medical attention, like burns, skin rashes or the flu  
Addressing new health problems—specific issues you’re experiencing, whether acute or chronic  
Blood work or lab tests to solve an acute or chronic problem