Using the Plan FAQs

I WANT TO SCHEDULE A ROUTINE EXAM AND WOULD LIKE TO KNOW WHAT SERVICES ARE INCLUDED. DO I NEED TO EXPLAIN MY ROUTINE BENEFITS TO MY PROVIDER?

When calling for your appointment, advise the office you are scheduling your routine physical exam. When you see your provider, explain that  your  routine physical exam benefit includes related lab testing.  Your provider is familiar with the American Medical Association (AMA) Preventative Care and Screening guidelines and will know the appropriate tests to perform.

 A routine physical exam is a medical exam given by a doctor when not in connection with the diagnosis or treatment of a suspected or identified disease or injury.  Preventive care includes services such as:  Routine physical exams, GYN exams,  immunizations for infectious disease, and associated laboratory and radiology services.   This includes a check of all body systems, discussion of the exam results with the patient or, in the case of a dependent child, the parent or guardian.  It includes materials for and the administration of immunizations of infectious disease, review and written record of the patient's medical history, and routine clinical screening tests (related labs) performed in connection with this exam.   Examples of routine related labs are too numerous to list all  but a few examples are CBC (complete blood cell count) , urinalysis, cholesterol and Lipidscreening, metabolic panel screening, fecal occult blood screening, cervical pap, PSA and EKG.  Please refer to your Summary Plan Description for a list of preventive services covered under the plan and age and frequency limits that may apply.

 If you  discover your claim was not processed as a routine physical exam please, contact  an LM HealthWorks Plan  representative @ at 1-877-458-4975 (8am - 8pm; Mon - Fri).

The LM HealthWorks representative will work with you and your provider  to resolve the claim payment for a routine physical exam.  

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