BILLING QUESTIONS

Please make payments to: “Overlake Internal Medicine Associates”
Payment Address: PO Box 84088 Seattle, WA 98124
Correspondence Address: 1407 116th Ave NE Suite 200 Bellevue, WA 98004

FREQUENTLY ASKED QUESTIONS

Has your office billed my secondary insurance?
Our policy is to first bill the patient’s primary insurance. After the claim has been processed, any remaining balance is the patient’s responsibility. As a courtesy, we will send a claim to the secondary insurance with the information that has been provided. However, it is the patient’s responsibility to follow up with the secondary to be sure the claim has been received and processed.

I have Medicare. What is the difference between an Annual Wellness Visit vs. annual physical vs. an office visit?
There is confusion from Medicare patients about what is covered under Medicare’s Annual Wellness Visit vs. an annual physical exam vs. an office visit so we will try to provide an explanation of the three types of visits here.

An annual physical exam differs from a Medicare Annual Wellness Visit. Medicare does NOT cover an annual physical exam but does cover an Annual Wellness Visit.

Annual Physical Exams: Medicare and most Medicare Advantage plans do NOT cover an annual physical exam. If your insurance carrier does not cover an annual/ preventive physical exam, you will be responsible for 100% of the associated charge. An annual physical exam includes:

1. Age- and gender-appropriate history and physical exam that includes height, weight, blood pressure, and an examination of all body areas (skin, eyes, heart/ lung, extremities, etc.).
2. Counseling regarding preventive screenings and referral to other specialists, as appropriate.
3. Ordering of laboratory and/ or diagnostic procedures.

Annual Wellness Visits for Medicare Beneficiaries (not a physical exam): Annual Wellness Visits do NOT include a physical exam by your physician, and additionally, they do NOT include the evaluation and management of new or chronic medical problems. These visits include items, such as a review of family and social histories, cognitive assessment, review of health risk factors, and health counseling and referrals. Medicare does cover an Annual Wellness Visit.

Office Visit: An office visit may be charged in conjunction with an annual physical exam or an Annual Wellness Visit if specific medical complaints or physician findings require additional evaluation and management. As an example, medical problems such as hypertension, diabetes, and joint pain that require ongoing assessment and management are handled during an office visit with your physician. The charges for these services may be subject to co-pays and deductibles.

Your visit with your physician will be appropriate for your health needs, and the billing will represent the specific service(s) provided. You (and your insurance) may be billed for one or more of the above. Ancillary services, such as labs and other diagnostic testing, will be billed separately from any of the above services. Please contact your insurance carrier for an explanation of covered services.

For more information about covered visits for Medicare Beneficiaries, please go to: http://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-examps.html