Wait A Full Year for Your Annual Exam?

Doctors AppointmentThe answer is “it depends.”  Many of us have had the unfortunate experience of scheduling our annual exam with our OBGYN or internist only to discover that our insurance company will only pay for the annual check-up once a year.  So if you had your exam on April 1st in the prior year, you have to wait until April 2 of the following year to have your exam covered by insurance.

The question you need answered by your insurance is: will they cover services on a year-to-year basis or on a calendar year?  If your insurance is on a calendar year, you can get the annual exam anytime each year.  If your insurance is on a year-to-year basis, you must wait a full year in order to get the annual exam again.  This is likely true for your yearly mammogram or your colonoscopy.  Making sure you know your insurance company’s rule can save you money by not scheduling the exam improperly.

So how should you plan your annual healthcare services?

  1. Know when you had your annual services in the prior year.
  2. Call your insurance company to find out whether they follow the calendar rule or the year-to-year rule.
  3. Ask your doctor how often you should have the exam?  For example, mammograms may be needed every year.  Colonoscopies, however, may only be needed every 5 years.  How often will depend on your age and your physical health.

Have you ever had your insurance denied for your annual exam because you went to the doctor too soon?  We’d love to hear from you.

For more information about your health insurance, see HealthSpin’s Easy Healthcare: Choosing Your Health Insurance.

We hope we’re helping you “Spin Your Healthcare Your Way!