Preventative vs. Office Visit: Know the Difference

What is a Split-Bill? Insurance often covers a yearly physical at no cost to the patient, but that physical is considered to be exclusively a preventative care appointment. The physical only includes your general screenings as a preventative measure for future health concerns.

If a patient presents with other problems or symptoms that need to be addressed while the patient is at FFM for their yearly physical, there may be an additional “office visit” charge to address those other concerns. Because a physical is meant to be a screening and preventative visit, any other symptoms the patient is experiencing would need to be addressed at a separate appointment. Rather than requiring the patient to come back on a separate day to address any new or unresolved concerns, we utilize split-billing to cover the services provided that are outside of the yearly preventative visit. Because there is a charge for the physical exam as well as the office visit to address the other concerns, we call this situation a “slit-bill” claim. Split-billing is typically only done when a “problem” or “complaint” is addressed during an appointment scheduled as a “physical.”

Our office would like to make patients aware of any split billing charges before they are included on the claim, but this is not always a possibility. Office staff is not required to inform you of this potential charge, but this reminder is posted in the patient rooms as a courtesy. You may ask about whether a visit will be split-billed, and you may request an itemized statement at any time to review the charges submitted to your insurance. This is best done by submitting a request by phone, text or email.