We attempt to provide the cardiac services for our patients that are reasonable and appropriate. Electrocardiograms are frequently included in regular examinations. Exercise stress tests may be required prior to certain procedures or at a time of change in lifestyle, beginning a weight loss program, joining a fitness club, etc. Many of these are not covered by insurance but we do our best to provide these services as may be appropriate. Patients should always discuss tests that are ordered or offered with their physician. Many outside parties such as health clubs, require certain diagnostic testing that cannot be done under an insurance plan, but, nonetheless, are reasonable screening examinations to detect potential disease. Likewise, prior to major surgery or other health interventions, it is important to exclude underlying heart disease that might increase the risk of procedures and operations.