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 prevention. But prevention is not only about making sure an ailment doesn’t occur, it’s 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?
To reduce this worry, it is important to understand two of the primary billing categories used, preventative and diagnostic.
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.
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.
Unsure which screening, immunizations or check-ups should be done when?
Here are a few resources to guide you.
Still not sure where to start?
Our Forsite Assist Team is here to help.
Call 920.593.1275 or email email@example.com.
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This Month's Nav Series Newsletter is a quick and easy read about preventive, routine care.
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