Timing of annual wellness/physical - less than 1 year?

[Anonymous]

Last year, I had my annual physical in December. For various reasons, I'l like to work on bumping it up earlier in the year, and scheduled it for mid September.

My insurance (Cigna) says that as long as it's billed as preventative, it's 100% covered, since it's in a different calendar year (but less than 12 months). But my provider says there's a chance I still may be billed, despite it being marked as preventative, because it's less than 12 months since my last screening.

What is your experience with bumping up your appts earlier in the calendar year? I always thought that once in a calendar year is covered? Is my provider, or Cigna, incorrect??

[Anonymous]

We cant know. There is always a chance who you spoke to at Cigna was wrong. Call again and get a managers approval.

[Anonymous]

Also have Cigna and earlier in the calendar year is fine.

Our providers always flag, though, because other insurers are different.

[Anonymous]

Get it in writing from Cigna.

[Anonymous]

You should read your policy. If what they tell you is wrong, it’s not binding so you’d have to pay.

FWIW, my kids’ ped won’t even consider scheduling before a full year has passed due to reimbursement issues.

[Anonymous]

I think most insurance won't let you do a physical less than 365 days from your last one. In fact, Inova primary care won't even let you schedule it (their software scheduling system doesn't allow scheduling an annual physical exam less than 365 days post last physical). So, that would suggest that it is very much not routine for insurance companies to pay for a physical just 9 mos. later.

[Anonymous]

As noted by many, most likely it needs to be 365+ days after the last appointment.

[Anonymous]

Thank you for the replies. I called Cigna again, and they reiterated that there is no minimal time between the visits - it's one per calendar year. They could not send me an email, but they gave me a case/reference number and their names/extensions.

So... hopefully this is sufficient. Hopefully...

December is just so busy, and I don't want to wait until January and miss a calendar year w/o a lab checkup.

[Anonymous]

Anonymous wrote:Also have Cigna and earlier in the calendar year is fine.

Our providers always flag, though, because other insurers are different.

+1 different insurance but ours is one per calendar year not 365 days.

[Anonymous]

How old are you? Why do you need a physical early?

Why not do it a few months late?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Also have Cigna and earlier in the calendar year is fine.

Our providers always flag, though, because other insurers are different.

+1 different insurance but ours is one per calendar year not 365 days.

Same here...we have United Healthcare and it is also a calendar-based policy, so we don't have to wait 365 days before the next appointment as long as it is in a different calendar year.

[Anonymous]

NP. My doctor won’t schedule within a year because they are concerned about the bloodwork being covered. I’ve thought about scheduling late the next few years to eventually get it where I want but I’ll call Anthem to check after reading some of these replies.

[Anonymous]

Aetna is one per calendar year. Every year my pediatrician questions me about it and every time that it’s been less than 365 days but different calendar years, it has gone through just fine.

[Anonymous]

Anonymous wrote:How old are you? Why do you need a physical early?

Why not do it a few months late?

Because if I wait until February, then I miss 2023 without getting a physical. It seems "wasted" with the premium I pay each month. Honestly, I'm not that concerned about my health in my early 40s, but I'm always curious about my labs (always normal, but I kind of want to make sure).

[Anonymous]

Document who you spoke with, date and time, in case you need to refer to it. Two times being given the same answer is good.