A Comprehensive Physical Exam, also known as a CPE, is a series of routine medical tests/exams that your healthcare provider performs to check your overall health. This notice pertains to the components of a physical examination (preventive services) that are and are not typically covered by Medical Health Plan coverage.

Physical Examination Components typically covered by Insurance plans:

• Review of Medical History
• An individualized review of medical risk factors
• Height, weight, blood pressure, BMI calculation
• For male, clinical testicular examination, and self-exam instruction
• For female, Pelvic Exam, Pap Collection, and Breast Exam with self-exam instruction
• Skin examination and counseling on skin cancer prevention
• General Assessment Screening, Vision and Hearing Screening
• Review and explanation of lab results, if applicable
• Screenings for common or preventable diseases. For example, screening for high blood pressure, obesity, high cholesterol, diabetes, and certain forms of cancer.
• Complete physical examination
• Review of immunization history and administration of any if necessary.
• Counseling on healthy living choices, normal development and recommendations for proper diet and exercise.

Laboratory Test(s), Screening test(s) or Diagnostic Test(s) may be ordered by your healthcare provider, to further evaluate and treat conditions. Please note, the below services may or not be covered at 100%, this will be determined once your claim is submitted and processed by your insurance carrier. Depending on if the service is screening or diagnostic, the below services may or may not be subject to a co-payment, co-insurance and or deductible.

• Bone Density Testing (Osteoporosis)
• Diagnostic Pap Smears
• Mammogram
• Diabetes Screen (blood lab test)
• Colonoscopy
• Cholesterol Screen (blood lab test), etc.
• Prostate Test (blood lab test)

Services that are not normally covered by insurance plans during a physical examination:

• Evaluation and management of specific acute problems or illness. For example, a discussion of a recent cough, sore throat, pain, or injury.
• Procedures such as mole removal, joint injections, and skin biopsies.
• Medication Management – Prescription Refills
• Chronic Care Management services

Laboratory testing is processed through our partner vendor, LabCorp. You may see their name on your EOB, or you may receive a bill from them for items not covered by your insurance plan. Please contact LabCorp directly with any questions pertaining to these items.

Vaccine administration is processed through our partner vendor, VaxCare. Any vaccine-related claim filing will show on your EOB under their organization name. You may receive a bill for any items not covered by your insurance. Please contact VaxCare directly with any questions pertaining to these items.

If you have additional health concerns outside of those normally covered by your medical health plan for a Comprehensive Exam, please speak to a staff member and/or Provider at the clinic. Additional health concerns may be able to be discussed during your preventive exam; however, there will be additional charge for an office visit at the time of service (co-pay, deductible, or co-insurance), or you may be instructed to schedule a separate appointment to discuss those concerns.

If your healthcare Provider finds any abnormal finding(s) during your “covered” Physical Exam, your healthcare provider will address the finding with you and document it/them in your medical record. Your healthcare provider can bill this abnormal finding as a separate Office Visit along with your Physical Exam to your insurance company. Please note, you (the patient) will be responsible for any co-pay, deductible, or co-insurance pertaining to the Office Visit, this payment should be paid at the time of service.