Preventive care includes immunizations, lab tests, screenings and other services intended to prevent illness or detect problems before you notice any symptoms. The right preventive care at the right time can help you stay well and could even save your life.
Diagnostic medical care involves treating or diagnosing a problem you’re having by monitoring existing problems, checking out new symptoms or following up on abnormal test results. Examples of diagnostic care include:
STD testing to diagnose a vaginal infection
Diagnostic mammogram and/or ultrasound to follow up on a breast lump or pain
Why does this matter?
Your insurance coverage may be different depending on which type of services you receive. Many preventive services are covered at 100% at no out of pocket cost to you. Many diagnostic services will come with a charge to you and will go towards your deductible.
How we code these services at our office
All health care providers bill for services using billing codes. These codes tell the insurance company what was done and why. It is not uncommon for patients to become confused between preventative/screening codes and problem/sickness codes—as they can occur in the same visit. While we recommend that you treat your problems and concerns at a visit separate from your annual exam, it may be unavoidable that a portion of your visit will require diagnostic testing.
For example, if a breast lump is discovered at your annual exam, you will be referred for a diagnostic mammogram and ultrasound, even if you are just due for a screening mammogram. Depending upon your insurance, any diagnostic testing may not be covered under your preventative benefits.
If you request STD labs be drawn during your annual exam, those lab services may or may not be considered preventative and will be billed accordingly. Depending upon your insurance company, certain tests are covered within the STD panel, while others are not and are applied to your deductible.
Because many insurance plans cover one preventative exam per calendar year, any other issues will be billed as problems and will then apply to your deductible. It is always best to check with your insurance provider to verify all benefits prior to having testing done.