IMPORTANT INFORMATION REGARDING MEDICARE & WELLNESS CARE
With new rules and changing guidelines, we wanted to take a moment to explain the
Medicare Wellness Exam protocols. Wellness care is an important health care tool that
may lower your risk of illness or injury. Medicare pays for some wellness care, but it
does not pay for all the wellness care you might need. We want you to know about your
Medicare benefits and how we can help you get the most from them.
The term “physical” is often used to describe wellness care, but Medicare does not pay
for a traditional, head-to-toe physical. Medicare does pay for a wellness visit once a
year to identify health risks and help you to reduce them. At your wellness visit, our
health care team will take a complete health history and provide several other services:
• Screenings to detect depression, fall risk, and other problems.
• A limited physical exam to check your vitals, such as blood pressure, weight, vision and other things depending on your age, gender and level of activity.
• Recommendations for other wellness services and healthy lifestyle changes.
• A self-completed Health Risk Assessment Questionnaire.
• This will be given to you before you are taken back to see the provider.
• You will be given ample time to review the questions & answer thoughtfully.
It is important to note that a Medicare wellness visit has a limited scope and does not
deal with new or existing health problems. Medicare strongly encourages providers to
perform wellness services when patients are feeling their best so that assessments and
baselines will be accurate.
To that end, if you have scheduled a wellness visit but find that you need your provider
to help with a health problem, changes to medications, or something else, please let our
staff know when you check in. We may need to schedule a new appointment to
complete the wellness visit when you are feeling better. Your provider will also suggest
rescheduling your appointment if they believe it is medically appropriate to address
acute or chronic issues instead of handling your wellness check.
These policies ensure that you are receiving the full benefit of your Medicare Wellness
Visit. When provided following Medicare’s specifications, the wellness visit is covered at
100%. Any additional services, even screening or preventive services, if they are not
included in the limited scope of this visit, may cause out of pocket expenses. Those
expenses will vary based on your medical history, age, and secondary benefits.
Please let us know if you any questions.
Sincerely,
Generations Family Practice
Updated July 16, 2015
IMPORTANT INFORMATION REGARDING MEDICARE & WELLNESS CARE
I verify that I have read and understand the notice regarding my Medicare Wellness
Visit, as well as coverage protocols, including:
• The Medicare covered Wellness Visit is not a complete physical exam.
• If I need to address current or ongoing medical concerns at a scheduled Wellness
Visit, I should notify the staff when I check in. • I am aware that due to Medicare limitations for this service, I may be asked by the staff or
provider to reschedule my wellness visit if I require medical attention outside the scope of the
wellness visit protocol.
• I understand that if I receive services outside of the Medicare protocol during this
visit, there may be out of pocket costs associated with those services.
_______________________________________
____/____/____
Patient (or legal representative) Signature
Date
_______________________________________
Patient Name Printed
-----------------------------------------------------------PATIENT REQUEST FOR NON-COVERED SERVICES
If you still wish to have a Complete Physical Exam performed in addition to your Annual
Wellness Visit, even though it is not a covered Medicare benefit, please initial the box next to the
statement below.
I request that Generations Family Practice provide me with a complete physical
exam at my appointment today. I accept financial responsibility for charges which
are not covered by my Medicare, Supplemental, or Secondary insurance plans. I
am aware that if the visit is denied in full, this may result in a balance of $350 or
more.
Updated July 16, 2015