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If This Was Preventative, Why Am I Receiving a Bill?
The Value & Cost of Annual Preventive Services
Preventative care is an essential element in your health and well-being. While preventative care visits are often covered by your medical insurance plan, you might still find yourself receiving a bill and asking why you're being charged for care if it's "preventative." Let's talk about what that means.
Preventative care is defined as "Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems." It's often care that comes before a set of symptoms or a diagnosis.
What's covered at no additional charge to you varies depending on your insurance plan and carrier. Let's talk about some different types of care and how they might be covered or billed:
Annual Preventive Physical Exams
Annual comprehensive physical examinations provide valuable insights into overall health and help identify any underlying health concerns. Annual exams are covered at 100% on most medical plans. However, it’s important to keep in mind that if new symptoms or health concerns are discussed during the visit, these are billable services.
Early Detection of Conditions
Screening tests, such as mammograms for breast cancer and colonoscopies for colorectal cancer, enable early detection and intervention, which in turn results in better outcomes. Basic screenings are generally covered at 100% for specific age groups when ordered for preventive reasons. However, whenever screenings are ordered because of symptoms or a follow-up for an existing condition (diagnostic) these are billable services.
Immunizations
Vaccinations are essential for preventing infectious diseases that pose a threat to public health. Many, though not all, immunizations are covered at 100% for specific age groups on most plans.
Labs and Radiology Services
There is a list of common preventive labs and radiology services that are covered at 100% on medical plans Affordable Care Act preventive program. However, not all services ordered for preventive reasons are on that list. For example, Vitamin D and Thyroid tests are billable services.
For more examples of preventive services that may be billable to you, read this article: Ouch. That 'Free' Annual Checkup Might Cost You. Here's Why.
Maintaining a proactive approach to your health helps reduce the risk of preventable diseases and allows for critical, early detection of threats to your well-being.
March marks the observance of Colorectal Cancer Awareness Month, a reminder of the importance of prioritizing preventive care for overall health and well-being. This is an opportune time to take proactive steps toward safeguarding your health and reducing the risk of diseases!
Understanding the difference between preventive and non-preventive services can help you know in advance what services will be covered at 100% versus what may be billed to you. In the end, taking the opportunity with preventative care is highly recommended, even if costs are incurred. Embracing preventive care allows for early detection, intervention, and the promotion of optimal health!
For questions pertaining to your healthcare plan or access to care, reach out to our Advocacy Team by calling 855-662-1029 or replying directly to this email.
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