Many of us are familiar with the old adage, "An Ounce of Prevention is Worth a Pound of Cure", as well as the benefits that accompany preventive care. A recent Kaiser Health Tracking Poll reported that 92% of Americans believe in the importance of an annual physical. That's great! But why are only 62% of Americans, according to the same survey, following through with their preventive care?
Prevention is not only about making sure an ailment doesn’t occur. It is also about early detection, which is often a key ingredient to favorable outcomes. Despite knowing these benefits, today’s complex healthcare system can leave some of us wondering or even worrying, "Will my preventive visit result in a surprise bill in the mail that I cannot afford?"
There are two primary billing categories used to code your doctor visit that will determine how your visit is given a price tag; preventative and diagnostic.
What are Preventive Services?
Preventive services are routine healthcare. These visits include screenings, immunizations and check-ups to prevent illness, disease, or other health problems. Specific services are considered “preventive” if they meet certain guidelines. For example:
· Having no current or past health conditions related (diagnosed) to the services being performed.
· Falling within the applicable criteria such as age and gender for needing the preventative service.
What are Diagnostic Services?
Diagnostic services are meant to identify (diagnose) a condition, disorder, disease or other problem by analysis of the health history, examinations, evaluations or tests.
Where things get complicated is when we go in for a preventive service and a concern or problem is discovered. At this moment, what we thought was a preventive visit can quickly shift to diagnostic as the Healthcare Provider looks to identify (diagnose) the cause. Its in this moment we must remind ourselves of the importance of early detection and its benefits.
We recommend contacting your insurance carrier to confirm your scheduled screening, immunization or check-up, is covered under your plan as preventive. Most preventive services must be covered by all plans and not subject to any cost sharing on your behalf as long as they have preventive bill code assigned to them.