Why is a copay collected during my wellness appointment?
Preventive wellness appointments are covered 100% by (almost all) insurances. Discussing chronic conditions, managing medication, or addressing medical concerns that arise during the visit are considered “evaluation and maintenance” and are coded as such, in addition to the wellness components. As these are technically out of scope for the wellness code, an appropriate office visit code is added which can incur a copay or co-insurance, consistent with your plan. As a majority of adult wellness visits include such an E&M component, a copay is collected. If the provider determines that the visit stayed within the framework of the preventive wellness, the copay will be refunded at check-out. In rare cases, the insurance company may later determine that an additional code is required, and the appropriate copay will then be billed.