What can and can’t I ask my doctor about at an annual exam? | Expert Opinion

Let’s say you have a few questions for your doctor, and you are also due for a yearly checkup. Makes perfect sense to do both of those visits in one, right?

Most patients are surprised to hear that a yearly checkup, also called an “annual exam,” is technically not the same as a visit to address your list of concerns and questions. In fact, your medical insurance views these visits differently.

Medical insurance typically allows for one annual checkup per year. This visit is free of charge for the patient, meaning no co-pay. At this visit, the physician addresses everything needed to keep you healthy, also called “health maintenance.” This will include a discussion of age-appropriate cancer screenings, reviewing use of alcohol and tobacco, recommendations on exercise and diet, and ordering labs to check on cholesterol, blood sugar, and so on.

What is not considered a part of this visit is the list of specific concerns most patients bring in with them. Appointments to discuss these are called “problem-based” visits.

As both a patient and physician, I find this differentiation frustrating. I am fully aware of the long wait time for primary care visits, and it feels unfair to place limits on the visit once my patient and I are finally sitting in front of each other. However, medical insurance dictates the time physicians are supposed to spend with patients, what tests are considered part of health maintenance, and how our office is reimbursed for this time.

Here’s how to be prepared and get the most out of your appointment:

Annual exams are invaluable for keeping people healthy in the long-term. When you call to make an appointment with your physician, ask the receptionist when you last had an annual exam. Most insurance companies will not pay for more than one of these visits a year. If it has not yet been a full year since this exam, you will likely have a co-pay for the visit. Asking for this information up front can save you both time and money.

Questions like, “How can I get help to quit smoking?” or “I’m concerned about my weight — what should I do?” are a good fit for an annual checkup.

If you have a list of concerns you need to discuss with your physician, schedule a “problem” visit. Use this type of appointment to review options for managing a chronic condition, like high blood pressure or diabetes. Problem-based visits are also the place to raise a new concern, such as a rash, onset of fatigue or other new symptoms, or concerns about a recent injury or pain. You’ll have more time at this type of visit to fully explore your questions and concerns.

Consider jotting down a list of your questions. You can ask about more than one concern, but be prepared to have more than one visit if the list is several items long. I want to take time listening to my patient so I can give thoughtful answers and order appropriate evaluations. If we don’t cover everything in one visit, I’ll know which issues to address at the next, thanks to your list.

Acknowledging that we likely won’t be able to address all medical issues at one visit, I encourage my patients to schedule their next visit before they leave the office. That way, we both feel confident that we will see each other back in a timely manner.

If you just had your yearly checkup but know that you often have questions in between these visits, go ahead and schedule a “problem” visit in three to four months, for example. That way you know you will have an opportunity to ask the questions that will appear in the interim. Or, if you have chronic conditions that need close monitoring, your doctor should give you guidance on how often they should see you.

Knowing the different types of medical visits can help you know what to expect at each and empower you to get what you need most from your physician.