Free Healthcare? Max Schedules His 2019 Preventive Physical Exam

Max OOP likes to think of himself as a pretty regular guy. I have a few hobbies, a career, and try to stay in pretty good shape. As a generally healthy person, I pump iron, do squats, and I even go on a long run here and there. I like a good burger, bonfire, and yes in my 30’s, I still listen to Eminem. I enjoy difficult mountain hikes, skiing, and visiting the highest tides in the world. I have thrown back ‘Baijiu’ in China, ‘Boli’ in Iceland, and even Moosehead in Canada. Believe it or not, I am even known to occasionally have a few too many brews on the weekend here in the States. I have even been stumbling through a questionable blogging career.

I am also not afraid to buck up and schedule my annual preventive physical exam.

After all, what’s the point of living a good life, with a plan to retire early, only to have it taken away by something that possibly could have been prevented?

Now that the battle between preventive and preventative is over, we can officially move on to my annual preventive physical exam.

An apple a day keeps the doctor away. Not if Max can help it.

Annual Preventive Physical Exam

Here at Max Out of Pocket, a big part of our financial plan is staying as healthy as possible for as long as possible. Keeping out-of-pocket medical costs low is a convenient byproduct of this decision, but I also just like feeling good. This involves eating healthy, exercising, and taking notice of anything unusual going on with my body. I also think it is a good idea to regularly get a second opinion annually on how I am doing with my strategy.

A medical doctor will help hold me accountable for staying healthy. Since I think of my health as a competition with myself, I need a coach. He or she may point out faults in my technique or notice something I have been completely overlooking. Already ripped? Great. Already eating healthy? Even better. Giant deformed mole on the center of my back that I cannot see or touch? An annual preventive physical exam of a seemingly healthy person like Max OOP just might catch something there.

I can already hear the whining.  

“But Max, I don’t have any spare time in my already crazy life to go see a doctor when I am perfectly healthy. Isn’t my overpriced CrossFit membership and three-mile run through suburbia enough?”

You aren’t that busy. How much time do you spend on Netflix per year? How much time do you spend eating out? How much time have you already put into planning your perfect early retirement withdrawal strategy?

An extremely elaborate and well-planned withdrawal strategy won’t do you any good if you are not here to withdraw it.  

“Point taken. But, what about the out-of-pocket costs?”

Good question. After all, I suppose the ultimate goal of this blog isn’t to debate the usefulness of this annual exam but to discuss ways of saving money on it.

Is The Preventive Health Physical Exam Free?

Working in healthcare, I have seen the struggle patients face when working their way through preventive health benefits. I was hoping this would be an easy post. A post proclaiming that every privately insured person the United States is entitled to one free preventive physical exam by their medical provider ‘on the house’ from their private insurance company every single year. I work in the billing and finance realm of healthcare and even I thought a free annual preventive physical exam was a standard of the Affordable Care Act for private insurance companies. But with research came more questions.

Unfortunately, we usually can’t say “always” in healthcare and like so many things in the field, it just isn’t that simple. Is your annual preventive health exam free? Max OOP is going to have to be careful here and say:

“probably, but it depends.”

Max, You Sound Like An Insurance Company

As we start digging around preventive health, we find a lot of it got mandated by the Affordable Care Act. Some of this surrounds market place plans, but for most private health insurance companies to be compliant with the Affordable Care Act, they need to offer certain preventive services free of charge. Those are outlined here:

Preventive Care Services For Adults

I won’t copy the list here, but if you take a long hard look at it, nowhere does it say we are entitled to a free annual preventive physical exam by a doctor.

All Marketplace health plans and many other plans must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.

Preventive Care Services For Adults

I will go on record saying that the Federal Register does suggest if the primary purpose of the office visit is the delivery of the recommended preventive care listed, the insurance may not charge you for the office visit. That said, there is some other language and nuances in there that we need to be careful on and work through. Also, there are grandfathered plans out there that technically don’t need to follow the Affordable Care Act yet. So, do we get a free visit? It depends.

I am currently digging a bit deeper into the Federal Register to get more clarity on this so we will get a whole post dedicated to that at some point. Also, using your preventive healthcare exam to have something specific checked (like abdominal pain) usually doesn’t qualify since the primary purpose of the visit is to check something that is already wrong.

Going To The Source

Since the insurance company has the ultimate say on if this exam will be covered, why not just ask them ahead of time? In fact, Max OOP is fairly certain I get a free preventive physical exam once per year with a doctor. How do I know? I asked.

Since we can never be too proactive when dealing with the healthcare system, I messaged my insurance ahead of time and specifically asked them. Here is the message:

Clearly before preventive won my allegiance here on the blog.

See, not all insurance companies are the devil. They kindly corrected my use of preventative and also gave me a nice summary flyer to help me understand my preventive health benefits.

Of course, Max OOP couldn’t wait to get home and dig into this fancy preventive care.pdf document my insurance company sent me. I figured it would be impossible to read and at least 300 pages long. That sounds like a great Friday night. As it turned out, it was just a two-pager, it was easy to understand, and the answer to my question was on the top of page two.

100% payment = free care = $0.00 out-of-pocket
Preventive physical exams are the first thing on the list.

All documentation so far points to the fact that my annual preventive physical exam is covered with no out of pocket cost to me. I also have this document if I happen to need it in the future. Time to move on to the next step.

Scheduling the Exam

So now that the research part was done, I was ready to move onto the scheduling piece. This process took approximately four minutes on the phone.

Normally when I own an investment such as medical office buildings, I will try to use that investment whenever possible in my regular life. You know, keep it in the family. Unfortunately, Physicians Realty Trust (DOC) does not own any medical office buildings in my area, so I was unable to schedule my preventive annual exam in one of the very buildings I own.

But that didn’t stop me from picking up the phone to call the primary care family medicine clinic in my area to say the following statement:

“Hi! I’m Max. I would like to schedule my free annual preventive health exam.”

Now, I happen to live in a rural setting where access to medical care can be a challenge. I even read about it in the papers sometimes. So I was wondering how long it would take them to get me into the clinic. I read the bios of several doctors in my area and listened to recommendations from our local community. I was able to narrow my list down to two doctors, and there is certainly a decent wait to see them; a 77 day wait.

My exam is scheduled for 10/30/2019.

Now keep in mind, the wait would be much shorter if there was something actually wrong with me. I made sure I clarified that with the office. The doctor that was my first choice was booked well into November. I still may change to him or try to get on a waiting list since I live relatively close to the clinic and could probably fill in a canceled spot. As of now, my appointment will be on or around 10/30/2019.

Max OOP vs. WebMD

As we should know already, I am not a medical provider so I should disclose here that WebMD and random studies from the internet appear to disagree with Max OOP on the usefulness of the annual preventive health exam. They list their sources and feel free to read those on your own time.

The annual physical exam is beloved by many people and their doctors. But studies show that the actual exam isn’t very helpful in discovering problems and may lead to unnecessary tests. Leading doctors and medical groups have called the annual physical exam “not necessary” in generally healthy people.

WebMD: Annual Physical Examinations

They do go on to say that no one can argue keeping a good relationship with your doctor through regular visits. I happen to agree that having a relationship with a physician could prompt faster or better service in a time of need. This is just another untested Max OOP theory, though. I also have some unnecessary lab tests I am interested in getting run. As I mentioned before, in the end, I am more concerned with how much I will owe for the exam and let others worry about the usefulness of the exam.

Final Thoughts

We seem to be able to follow regular maintenance schedules on our overpriced cars, but we don’t seem to take the time to do the same for ourselves. Scheduling this exam is the first step in the right direction. Taking a proactive approach to researching the coverage before the exam will be key in safeguarding against a surprise medical bill after the exam. It is pretty likely the exam will be free, but due diligence is a must in healthcare. We need to start taking some accountability for figuring this stuff out ahead of time.

Don’t worry, I still eat my apples. But I also drink my Moosehead, too.

Probably still worth a shot to keep other doctors away.

If you haven’t noticed, we like to run experiments here at Max Out of Pocket. I take meticulous notes along the way so we can all learn a thing or two. Scheduling this preventive exam marks the start of a new experiment. I will track all the gritty details so we might know what to expect at this exam in the future.

What exactly will occur at this exam? How much time will it take? What will the price be before insurance processes? Will my insurance actually pay the full out-the-door price? How does the coding look? Will other tests be ordered? How much facetime will I get with the actual doctor? These questions will all be answered, so stay tuned!

Have you scheduled your 2019 preventive health physical exam visit yet?

Usual disclaimer: I am not a medical provider and not responsible for your healthcare decisions. Those decisions need to be between you and your medical provider. I also have no idea how your actual insurance will process a claim for this exam. Hopefully, they pay it in full though.


4 Responses

  1. Dragon Guy says:

    I’ve got my annual wellness exam scheduled later this month. I usually have to call about 60 days before to get the dates and times I want (the earlier in the morning the better because of the whole fasting thing). I’ve been seeing my current doctor for 5 or 6 years now. I think he spends a decent amount of time with me and has a checklist of things to go over with me. He also gives me ample time to ask him any questions about things on my mind.

    My company recently started a program where we get penalized on our insurance premiums if we don’t get an annual wellness exam. We have to submit a form from the doctor saying that we had certain blood tests performed. By doing that I save $50 per month on my health insurance premiums.

    I have never had to pay anything for the annual exam. I have never figured out what the non insurance costs would be as there usually are multiple claims for the event and I have never bothered to add all of them up. One of 5hese years perhaps insurance companies will just put all of that into one claim!

    • Max OOP says:

      Thanks, Dragon Guy. Also good to score a morning appointment because it is less likely the medical provider will be behind schedule and make you wait. Mine will be at 8 am. I have heard about companies penalizing people for not having this exam. My previous employer was a hospital, so they didn’t enforce an exam but did have us draw certain labs annually. The first year was optional and they slowly moved it into being mandatory. I hope you are right about the claims being simplified in the future, I am going to walk through that process soon!


  2. Lordosis says:

    As a family physician I find many people confused on this topic. It is a common misconception that you will get 1 free exam a year and people get upset when they are charged because they have other medical problems. I personally do not add extra EM Coding unless we actually address the medical issues to some significance. For example you might be a diabetic but be well controlled on a few medications and we can comment on that and move on. However if it is poorly controlled and needs to be adjusted or investigated then we have moved beyond the level of the physical.
    I have heard of physicians who will charge everyone even if everything is normal
    I have heard of physicians who do not charge anyone even if they spend 2 hours dealing with an issue.
    I think my way is best but I may be a little biased…

    Great post!

    • Max OOP says:

      Thanks so much for the feedback!

      I agree with your approach of not adding the separate E/M to address a problem unless significant time and resources are used. I think applying common sense to these concepts goes a long way. I did notice during my visit the Medical Assitant specifically asked me if there was anything else I wanted to address during the physical. I was thinking that scripting was used to try and avoid confusion, but I could certainly see other things coming up during the visit with the MD/DO. People are usually more comfortable talking with the physician.

      Just out of curiosity, how long do you normally spend with a healthy patient (mid-30’s) during a routine physical? I was actually somewhat disappointed with the thoroughness of my exam back in October. It was basically a line of questions and an extremely brief (less than 1 min) physical exam. I am not sure I should have expected more considering I am perfectly healthy? Is your clinic tied to a health system?


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