Overview:

One of the most important ways to minimize your health care costs is to be knowledgeable about your visits to the doctor. Most visits usually fall under two different types: physical or office. What is the difference between physical vs. office visits, and how do they work? Physical visits remain one of the most important ways to keep costs down. The sooner your doctor discovers a potential issue, the sooner they can treat it. That also increases the likelihood that the treatment will be less expensive than if you delay treatment. Insurance considers these visits preventative. An office visit, in contrast, is a visit when you visit your doctor for a specific symptom or concern. Treatment received at an office visit is usually not preventative, and so you will be responsible for some of the costs, depending on what all your insurance covers.

Physical vs. Office Visits:

A physical visit is your routine annual check up. The ACA mandates that these visits are free once a year. The physical’s purpose is to discover health problems before they become serious. A physical does not include tests or treatment. If you don’t want to pay anything out of pocket for a physical, you should speak to your doctor about only performing screenings that insurance considers preventative. If you don’t, your doctor may run extra tests that insurance does not cover as preventative.

An office visit, in contrast, is when you visit the doctor for treatment of specific issue. These are the visits you schedule when you don’t feel well. During these visits, the doctor provides their opinion and treatment plan, and you are responsible to pay for the service. That payment usually takes the form of a copay or a payment toward your annual deductible. If you have already met your deductible during the year, your insurance may cover most if not all of the fee.

It is possible that you can have both a physical and an office visit at the same time. If you go in for your physical, but your doctor treats you for a medical issue, you will be billed for both services. Insurance will cover the preventative aspects of the physical, and you will be charged for the office portion of the visit.

Out-of-Pocket Expenses:

Even though your insurance will cover the costs of your physical, you may be responsible for a small copay. You will ultimately be responsible for any services that your insurance will not cover. The best way to reduce your out-of-pocket expenses then is twofold. First you should schedule a physical visit once a year. This will help to catch small problems before they become big ones. Second, you should speak with your provider about what they cover. Some plans limit the number of office visits, tests, or physicals you can receive per year. You can also check with them before you visit the doctor to make sure that your service will be covered. If you know what services you need, having the insurance company give you an estimate is a great way to manage your out-of-pocket costs and create a plan.