Questions

We see patients all year long for problem/sick visits, but we strongly encourage all patients to schedule a complete physical exam annually. Changes in the healthcare industry are always ongoing. Insurance carriers define an annual physical as an opportunity to review stable problems and health preventative items. The annual physical is not intended to address new complaints.

An annual complete physical is different than an Annual Wellness Visit. Some insurance carriers will only cover an Annual Wellness Visit, which is a series of questions regarding preventative screenings. There is no physical exam in a Wellness Visit. Below is a list of procedure codes for annual physicals. We strongly encourage you to contact your insurance carrier and ask if the applicable procedure code is a covered benefit under your plan.

New Patients Established Patients
19-39 yrs old – CPT Code 99385 19-39 yrs old – CPT Code 99395
40-64 yrs old – CPT Code 99386 40-64 yrs old – CPT Code 99396
65 and older – CPT Code 99387 65 and older – CPT Code 99397

Depending on your age and any medical problems you may have, blood work is often a part of a complete physical examination. Blood may be drawn before, during, or after your scheduled physical. If you have blood drawn a few days prior to your appointment, your doctor will then review the results with you the day of the physical. If your blood is drawn during or after your physical, we will call you with the results within a few days. We do not have a policy of “no news is good news.” If you do not hear from us, be sure to give us a call so that we can make sure your results were received and convey those results to you.

Before having blood drawn, check with your insurance company to find out what laboratory facility your insurance plan says you must use. This will avoid confusion and prevent the cost of the draw and the lab work from being added to your bill.

The MLIM office does not draw blood outside of appointments. If you would like to have your blood drawn before your physical, please use one of the many outside labs to have your blood drawn. You may request a prescription for the lab work in one of two ways:

  1.  Call the office at (412) 942-8500, and ask for a lab slip.
  2. Use the online Message Request Form; when you type your message, ask for a lab slip to get pre-physical blood work.

Check with the lab to see how long it will take for blood work results to reach MLIM. Schedule your lab visit to ensure that the results will be at MLIM in time for your physical.

A reminder: Plan to fast for at least 12 hours before the blood draw.

Because of the rising cost of medical care, some insurers are changing their policies regarding payment for laboratory tests. Simply speaking, lab tests are of two types: diagnostic tests and screening tests.

Diagnostic tests. Your doctor orders diagnostic tests when he or she becomes aware of signs or symptoms of a specific problem or when monitoring the course and treatment of disease or injury. Even if a test is ordered to monitor a disease, some insurers place a limit on how often the company will pay for it for you. If your doctor believes that a test must be performed more often than your insurer allows and you choose to follow your doctor’s advice, you will be responsible for paying for the test.

Screening tests. Your doctor may order screening tests as part of a checkup or annual exam. In general, screening tests are performed to try to prevent health problems, rather than treat them. Appropriate screening tests are based on factors such as your age, personal and family history, and generally accepted medical practice. Some insurers place a limit on the number of times the company will pay for a specific test for you. If you choose to have the test regardless of the insurer’s limit, you will have to pay for it.

Deciding whether to have a test your insurer won’t pay for. Tests ordered for screening purposes can be an invaluable tool in managing your health. They can confirm your general well-being or indicate that a health problem exists – even before symptoms appear. If your insurance will not pay for a test, does that mean you don’t need it? No. Whether a test is appropriate is based on a discussion between you and your physician, regardless of whether an insurance company will pay.