By Britt Johnsen and Emily Hulstein
If you want to stay healthy, preventive care is a must.
Fortunately, many preventive care services are free under the ACA. When the new healthcare rules passed, insurance companies became required to provide full coverage for certain services.
These services have to be in-network, and they include things like regular checkups, screenings and immunizations. These services have a number of benefits:
- Helps detect the possibility of serious conditions as soon as possible so that they don’t have a chance to progress into later stages.
- Helps doctors to evaluate your health and make sure you are getting the right screenings based on your age, gender and family history.
- Helps you stay healthy and keep money in your pocket.
The difference between a preventive visit and an office visit are that preventive services help you check for issues while you’re healthy. An office visit, however, treats a specific problem or medical condition.
How do you get the most out of these services? Here are some important tips:
Discussing or receiving care for an existing symptom or problem while at a preventive visit may not qualify as preventive care, and thus may be subject to deductibles, co-pays or co-insurance. Issues related to coverage of preventive care do occur, and quite frequently. It’s one of the biggest problems related to this change under the ACA. If you receive a bill after receiving preventive services, contact your provider. Many billing issues or errors, related to preventive services, are cause by procedure coding problems. Some preventive services may require more than one billing code to be used, and your insurance provider may not consider a code qualify as preventive. It may be possible for your provider to re-submit your bill under a different code, or talk with your insurance carrier on the discrepancy.
Receiving tests or services considered “preventive” while at a visit will not be considered preventive if you get them as part of a visit to:
- Diagnose a new condition
- Monitor an existing condition
- Treat an illness or injury
If your doctor recommends additional tests, you will want to clarify whether or not these are covered under your plan. Always make sure you know what tests you are receiving and whether or not they are considered preventive – and then covered.
How to learn more:
Trig also has a number of tools available to assist you with your preventive care. Check them out here.
Do you have any questions? Feel free to contact your Health Risk Consultant, who can help you anytime with questions about your coverage, about preventive care services, and more.