What is covered as part of a routine physical?
Posted: April 29, 2013
Last week we talked about what tests and examinations are involved in a "routine physical" for most college, graduate and professional students. Now we're going to talk about some special situations in which a physical might entail something different.
It's important to note that health insurance companies vary as to what preventive medicine services they will pay for. Most base their coverage on the recommendations of several expert groups who have studied the relative value of various screening tests, immunizations, and health counseling. These groups include the CDC (Centers for Disease Control and Prevention), the USPSTF (U.S. Preventive Services Task Force), the American Cancer Society, the ACOG (American College of Obstetrics and Gynecology), the ACIP (Advisory Committee on Immunization Practices - part of the CDC) and others.
Fortunately, students between the ages of 18-45 who are in good health don't require many preventive measures. Those that are generally recommended (and covered by insurance) are:
- Annual flu (influenza) shots
- A tetanus booster every 10 years (the shot actually prevents diphtheria and pertussis as well)
- The HPV vaccine (Gardasil)- a series of three shots that prevent Human Papilloma Virus infection
- Counseling about quitting tobacco use
- Counseling about healthy alcohol intake
- Counseling about physical activity
- Counseling about weight
- Screening for the STD's chlamydia, gonorrhea, HIV, and syphilis
Other screening tests may be recommended (and covered) in certain situations. These include:
1. Cholesterol screening IF:
- you are over age 35 (men) or over age 45 (women) OR
- you are obese OR
- you have a biologic brother, sister, mother, or father who has a history of Sudden Cardiac Death or cardiovascular disease (like a heart attack or heart surgery)
2. Updates on other immunizations if you have not received all the recommended shots as a child
3. For women, an annual pelvic exam, which usually includes a PAP smear and screening for STD's
What about an actual physical examination? Believe it or not, doing a head-to-toe complete physical isn't recommended by most of the groups above because it's never been shown to be an effective way to screen for hidden health problems. SOME insurance companies do cover these physical exams, but the specifics of what is included may vary based on your age. For example, hearing and vision screening is often included for children and older adults, but not for young adults. When in doubt, check with your insurance company.
If you have any questions about your health or what exams, tests and immunizations you need, you should make an appointment to see us at the Student Health Center - we're always glad to help.
And check back next week, when we finish our series on physicals by discussing the different kinds of physical exams you may come to see us for.
Mary Jane Elam, MD
Student Health Services
The Ohio State University