Insurance & Costs
PREVENTIVE MEDICINE AT NORTHWEST INTEGRATIVE MEDICINE
Understand what preventive care is, how it differs from problem-focused medical care, which preventive services we commonly provide, and which services are likely to be low or no cost to you.
PREVENTIVE CARE VS PROBLEM-FOCUSED CARE
Preventive care is designed to help you stay healthy, identify potential concerns early, and make sure you’re up to date on recommended screenings, exams, and vaccines.
Problem-focused care is different. It’s used to address symptoms, an ongoing medical condition, a medication concern, or another health issue that requires evaluation, treatment, or follow-up.
One easy way to remember is that preventive care is the care you choose when you’re feeling well, with the goal of helping you stay well. Problem-focused care is for when you’re having symptoms.
PREVENTIVE CARE
Focuses on keeping you well and identifying health risks before they become active problems.
- Annual preventive exams
- Well-child visits
- Well-woman preventive care
- Age-appropriate screenings
- Vaccinations
- Preventive counseling
PROBLEM-FOCUSED CARE
- Focuses on evaluating, treating, or following a symptom, diagnosis, or ongoing medical concern.
- New symptoms or health concerns
- Chronic-condition management
- Medication changes for active conditions
- Follow-up of previous health problems
- Detailed evaluation of multiple concerns
- Development or adjustment of treatment plans
Why this matters for your bill: Preventive and problem-focused services are often billed as seperate services. If both types of care are provided during the same appointment, your insurance plan may apply a significantly higher copay, coinsurance, or deductible to one of the services.
To help keep billing clear and reduce unexpected charges, preventive appointments at Northwest Integrative Medicine are generally focused on preventive care exclusively. If you would also like to address new symptoms, chronic conditions, medication changes, or other ongoing health concerns, we generally recommend scheduling a separate appointment.
Common Services
PREVENTIVE SERVICES WE COMMONLY PROVIDE AT LOW OR NO COST
Many insurance plans cover preventive care with little or no copay, coinsurance, or deductible. These are the preventive services most commonly covered for our commercially insured patients. If you’re looking for a more complete list, View our complete Preventive Services Guide (PDF) for additional screenings, vaccines, counseling services, and age-based recommendations.
WELLNESS & PREVENTIVE VISITS
- Infant preventive visits
- Well-child visits
- Adolescent preventive visits
- Adult preventive visits, ages 18–39
- Adult preventive visits, ages 40–64
- Preventive visits for adults age 65 and older when covered by the patient’s plan
SCREENING & PREVENTIVE COUNSELING
- Developmental screening
- Caregiver-focused health-risk assessment
- Vision screening
- Blood glucose screening for diabetes risk
- Tobacco-use screening and cessation counseling
- Alcohol and substance-use screening and brief intervention
AGE & RISK-BASED PREVENTION
Your provider may review additional screenings, vaccines, and preventive recommendations based on your age, health history, family history, pregnancy status, and individual risk factors.
A service that is preventive for one patient may be diagnostic or problem-focused for another, depending on why it is performed.
Important: To confirm which preventive services your insurance may cover at little or no cost to you, please reach out to them directly. There is no promise of coverage, and your insurance company makes the final coverage determination.
Choosing the Right Preventive Appointment
ANNUAL, SPORTS PHYSICAL, WELL-WOMAN VISIT, WELL CHILD CHECKS
ANNUAL PREVENTIVE EXAM
A general preventive checkup focused on your overall health.
- General physical examination
- Review of personal and family history
- Review of medications, herbs, and supplements
- Recommended vaccinations
- Age- and risk-appropriate screening recommendations
- Discussion of preventive lifestyle factors
SPORTS PHYSCIAL
Focuses on whether you can safely participate in a sport or activity.
- General physical examination
- Musculoskeletal assessment
- Cardiovascular and respiratory assessment
- Review of past sports injuries
- Sport-specific risk assessment
- Completion of a patient-provided clearance form
Sports physicals do not replace a comprehensive annual preventive exam.
WELL-WOMAN PREVENTIVE EXAM
- Focuses on preventive reproductive and gynecologic health.
- Appropriate general, breast, and pelvic examination
- Cervical cancer screening when due
- Discussion of reproductive health and family planning
- STI screening when indicated
- Review of recommended women’s health screenings
PAP TEST
A Pap test is a specific cervical cancer screening test. It may be performed during a well-woman visit when it is due, but it doesn’t constitute the entire well-woman examination.
WELL-CHILD CHECK (WCC)
A preventive visit focused on your child’s growth, development, and overall health.
- General physical examination
- Height, weight, and growth tracking
- Developmental and behavioral screening
- Review of nutrition, sleep, activity, and safety
- Recommended vaccinations
- Age-appropriate vision, hearing, and other screenings
- Guidance for parents and caregivers about healthy development
Well-child checks are designed for preventive care. If your child has a new illness, injury, ongoing condition, or other specific health concern, a separate problem-focused visit may be recommended.
Frequently Asked Questions
PREVENTIVE VISIT QUESTIONS
Coverage for Oregon Health Plan (OHP / Medicaid) members
OHP (Medicaid) plans cover preventive services for eligible members with no out-of-pocket costs. OHP members generally do not currently have cost-sharing for any covered service, but coverage for any individual preventive care service still depends on your specific plan, CCO, provider eligibility, and applicable coverage requirements. If you have questions, please call the Member Services phone number on the back of your insurance card.
Coverage for Medicare patients
Providers here at Northwest Integrative Medicine are unable to work with patients who have Medicare at this time, as our providers are not in network. Medicare does not allow naturopathic providers to bill for medical services.
Why a preventive service may still have an out-of-pocket cost
- Your provider or clinic is out of network for your plan.
- You do not meet the plan’s age or risk requirements.
- You’ve already received an identical preventive care service within the last year, and your plan only allows coverage for the entire cost once per year.
- A separate medical problem is evaluated or treated during the preventive visit.
- An associated laboratory test, vaccine, procedure, or administration charge is not covered at 100%.
- Your particular plan has coverage rules or exclusions that differ from other plans from the same insurer.
What is a preventive visit?
A preventive visit is an appointment focused on maintaining health and identifying potential health issues early. It may include age-appropriate screening, preventive counseling, a routine physical examination, and recommended vaccinations.
What is not included in a preventive visit?
Preventive visits do not include evaluation of new or existing symptoms, management of ongoing or chronic conditions, medication changes for active diagnoses, development or adjustment of treatment plans, or follow-up of previously treated medical problems.
Can I discuss any symptoms or active problems during my preventive appointment?
We generally discourage it. The problem-focused portion is likely to be billed separately and result in some out-of-pocket costs, including a potentially higher-than-average copay, coinsurance, or deductible. To reduce unexpected costs and allow enough time for your concerns, we recommend a scheduling a separate appointment for problem-focused issues.
Are preventive services always free with commercial insurance?
No. Many qualifying preventive services are commonly covered without patient cost-sharing, but coverage depends on your individual plan and whether all preventive-care requirements are met. Please confirm your benefits directly with your insurance company.
Información para pacientes
Atención preventiva y cobertura del seguro
La atención preventiva está diseñada para ayudarle a mantenerse saludable, identificar posibles problemas de salud de manera temprana y asegurarse de que esté al día con las evaluaciones, exámenes y vacunas recomendados.
La atención enfocada en un problema médico es diferente. Se utiliza cuando usted tiene un síntoma nuevo, una enfermedad en curso, una pregunta sobre medicamentos u otro problema de salud que requiere evaluación, tratamiento o seguimiento.
Muchos planes de seguro cubren la atención preventiva con poco o ningún copago, coseguro o deducible. Los servicios que aparecen a continuación se encuentran entre los que con mayor frecuencia están cubiertos para nuestros pacientes con seguro comercial.
Si desea consultar una lista más completa, vea nuestra Guía Completa de Servicios Preventivos (PDF), que incluye evaluaciones adicionales, vacunas, servicios de consejería y recomendaciones según la edad.
Atención preventiva
- Exámenes preventivos anuales
- Visitas preventivas para niños
- Atención preventiva para la salud de la mujer
- Evaluaciones apropiadas para la edad
- Vacunas
- Consejería preventiva
Atención enfocada en un problema
- Síntomas o preocupaciones nuevas
- Manejo de enfermedades crónicas
- Cambios de medicamentos para enfermedades activas
- Seguimiento de problemas médicos anteriores
- Evaluación detallada de varias preocupaciones
- Desarrollo o ajuste de planes de tratamiento
Por qué esto importa para su factura: Los servicios preventivos y los servicios enfocados en un problema pueden facturarse por separado. Si ambos se proporcionan durante la misma cita, su plan puede aplicar un copago, coseguro o deducible a la parte de la visita relacionada con el problema médico.
Servicios preventivos comunes en NWIM
- Visitas preventivas para bebés, niños y adolescentes
- Exámenes preventivos para adultos
- Evaluación del desarrollo
- Evaluaciones de riesgos para la salud
- Examen de la vista
- Pruebas de glucosa para evaluar el riesgo de diabetes
- Evaluación y consejería para dejar el tabaco
- Evaluación del consumo de alcohol y otras sustancias
- Vacunas recomendadas según la edad y los factores de riesgo
Seguro médico comercial
Según nuestra experiencia reciente de facturación, los servicios preventivos de esta página se encuentran entre los que tienen mayor probabilidad de estar cubiertos sin copago, coseguro o deducible por los planes comerciales que utilizan nuestros pacientes cuando se cumplen los requisitos del plan.
No podemos garantizar la cobertura. Confirme sus beneficios directamente con su compañía de seguros.
Oregon Health Plan (OHP / Medicaid)
OHP cubre servicios preventivos para los miembros elegibles. Actualmente, los miembros de OHP generalmente no tienen costos compartidos rutinarios por la atención preventiva cubierta. Sin embargo, la cobertura depende del paquete de beneficios, la CCO o cobertura Open Card, la elegibilidad del proveedor y otros requisitos aplicables.
Medicare
Northwest Integrative Medicine no factura a Medicare por los servicios proporcionados por médicos naturópatas. Si tiene Medicare, comuníquese con su plan antes de programar una cita para determinar si su atención en Northwest Integrative Medicine está cubierta.
Antes de su cita:Comuníquese con su compañía de seguros para confirmar que su proveedor de NWIM está dentro de la red y que el servicio preventivo específico está cubierto bajo sus beneficios preventivos. Pregunte también si existen requisitos de edad, frecuencia, diagnóstico u otros requisitos.