Scheduling: Your coverage and limitations.


Here at Go Red For Women, we’re getting the word out for women to have their annual “Well-Woman Visit” It’s what we call your yearly physical check-up with your doctor, and it’s a great way to help detect early signs of heart disease and stroke so you can begin treatment or make lifestyle changes before risk factors become life threatening.

The best news is that most private health insurance plans, as well as Medicare, are now required to cover 100% of the cost for preventive services such as an annual Well-Woman Visit. You won’t be charged a copayment or deductible – as long as you choose a health care provider in your health plan’s network.

As everybody knows, understanding health care policies and coverage can be confusing. Here are some tips to make it easier.

First, make sure your health plan provides free preventive services coverage. If you receive your health coverage through Medicare or you enrolled in a plan through your state’s health insurance exchange or, those plans all cover preventive services with no cost-sharing. Most coverage provided through employers also cover preventive services at no added cost – however, to be sure, you should check with your Human Resources Department or your insurance company directly.

Second, before you book the appointment to have your annual Well-WomanVisit, make sure you are seeing a doctor or health care provider who is part of your insurance network. There are lots of different health insurance plans to choose from, and they come in a range of prices. When you choose a policy, a simple rule of thumb is that the lower the price of the coverage, the more limited your choice of doctors will be. When you choose higher priced coverage, you have more flexibility regarding what doctor you can see and still be covered by your policy.

You can find a doctor in your plan’s network by using your health plan’s provider directory (this should be available on your insurance company’s website or you can call your insurer and ask that they send you a copy). When you call to make your appointment for your Well-Woman Visit, have your insurance card handy and be sure to ask if they are part of the network your policy allows you to visit. Otherwise you might be surprised by a hefty bill when you check out. Finally, be sure to make it clear that you are coming in for a Well-Woman Visit.

As long as you are seeing a doctor in your network for preventive services, you won’t be charged a co-payment. A “co-pay” is the fixed payment you will be expected to give the doctor’s office for a regular office visit. Since your Well-Woman Visit is considered a preventive service, you won’t be charged a co-pay. On the other hand, if you go to your doctor to be treated for a sore throat or a sprained ankle, then you can expect to be charged a co-pay even if the doctor is in your network.

Most health insurance policies also have what’s called a “deductible.” Your deductible is the amount that you are expected to pay out-of-your-own-pocket before your insurance company begins to pay. Your Well-Woman Visit and other preventive services are not subject to your deductible, meaning that you will not have to pay anything even if you have not yet met your deductible.

For more information to help you navigate the often confusing world of health insurance coverage, here is a helpful link: