Top 5 Questions to Ask When Booking a Preventive Care Visit

Author: Samantha Bridge, RN, MSN, MBA-HCM, IQCER
Date: May 3, 2025

Many people think preventive care visits are always “free.” But one wrong billing code—or a single unexpected question asked during your appointment—can turn your “free” visit into a surprise bill. So let’s walk through 5 smart questions to ask when booking, plus what to double-check after the visit to make sure everything gets billed correctly.

🩺 Top 5 Questions to Ask Before Your Preventive Visit

1. Is this visit considered preventive under my insurance plan?

Ask: “Can you confirm if this visit will be billed as a preventive exam, not diagnostic?”
Why it matters: If you talk about new symptoms or health concerns, the visit may be re-coded—and not fully covered.

2. What services are included in the preventive visit—and what’s not?

Ask: “Will labs, tests, or vaccines be included, or are those billed separately?”
Why it matters: Some labs (like vitamin D testing or thyroid panels) might not be covered unless you have a specific diagnosis.

3. Is the provider in-network with my insurance?

Ask: “Can you confirm the provider is in-network under my plan name?”
Why it matters: Even within the same health system, billing departments can use different codes. Always double-check your specific plan—not just the insurance company name.

4. Will there be a separate charge if I ask about other issues during the visit?

Ask: “If I bring up another health issue, will that change the type of visit?”
Why it matters: The moment you go from “routine screening” to discussing a new concern (like pain or symptoms), the provider may bill it as a diagnostic visit—which isn’t always free.

5. What CPT code will you use for this visit?

Ask (if you’re extra prepared): “Do you know which CPT code will be used for the preventive visit?”
Why it matters: Common codes for preventive visits include 99385–99397. You can call your insurer ahead of time with this code to confirm it’s covered under your plan.

📬 After the Visit: What to Check on Your Bill or EOB

1. Look for “preventive” language on your Explanation of Benefits (EOB)

Your EOB should say something like “annual wellness” or “preventive care” and show a $0 charge to you. If you see “diagnostic” or “problem visit,” it may have been coded differently.

2. Check the provider and lab names

Sometimes, your bloodwork gets sent to an out-of-network lab—even if the provider is in-network. That can lead to unexpected charges.

3. Ask for an itemized bill

If you receive a bill, request an itemized version. Sometimes billing mistakes happen (e.g., duplicate charges, wrong visit type). Don’t be afraid to question what’s listed.

4. Request a corrected claim if needed

If the provider agrees something was coded wrong, they can resubmit the claim. You can also appeal directly to your insurer if they deny coverage in error.

What If Your Preventive Visit Gets Denied?

If your insurance denies part (or all) of your preventive care visit—even when you did everything right—you have the right to appeal.

🧡 At EZ Med Appeal, we help people figure out why they were denied and how to push back. Whether it was a coding issue, an unexpected lab charge, or just plain insurance confusion, we’re here to make appeals easier.