You are correct - the pap and the exam are included in the first antenatal visit - the patient is not being provided with an annual well woman exam, they are being provided with an initial obstetrics evaluation, of which a pap is a recommended part.
ACOG guidelines via UHC:
First Prenatal Visit (8-10 weeks of pregnancy if first contact earlier)
Assessment • Initial history and physical. • Family medical history. • Genetic history. • General exam to confirm pregnancy. • Complete needs assessment. • Preterm labor risk, education and prevention. • Assess for tobacco, alcohol, drug use. • Domestic violence screening. • Prescriptions: prenatal vitamins and iron supplementation as necessary.
Education and counseling • Scope of care provided in the office and anticipated schedule of visits. • Advise regarding specific complications. • Discuss lab studies/testing; expected course of pregnancy; genetic counseling and testing including Cystic Fibrosis (CF) and tests for aneuploidy; HIV counseling/education; breastfeeding, choosing the child’s physician • Education regarding: Labor and delivery, nutrition, exercise, working, air travel, routine dental care, tobacco use and smoke exposure, alcohol/drug consumption, etc. • Practices to promote health maintenance such as use of safety restraints including lap and shoulder belts • Encourage prenatal classes • Encourage maternity program enrollment • Offer influenza vaccination, regardless of the stage of pregnancy, if the woman will be pregnant during the influenza season.
Laboratory/diagnostic studies • Type and screen • CBC for H&H and MCV • Hepatitis B surface antigen (HBsAg) • RPR • Chlamydia if ≤ age 25 or >25 with risk factors2 • Screening for gestational diabetes if at high risk (see section on gestational diabetes below) • HIV testing unless they decline (opt-out approach) •
Pap smear (if not done pre-pregnancy) • Urinalysis including microscopic examination • Urine C&S • Any additional testing indicated by the risk assessment or genetic history