Under the health care law, many insurers are required to cover certain preventive services at no cost to you. If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a co-payment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider
Some examples of covered screenings: blood pressure, cholesterol, colorectal cancer, type 2 diabetes, breast cancer, some immunizations, etc.
There are three categories:
- Covered Preventive Services for Adults
- Covered Preventive Services for Women, Including Pregnant Women
- Covered Preventive Services for Children
A comprehensive list of the preventive services covered can be found at http://www.healthcare.gov/prevention/index.html.
The most important thing to remember when seeking these preventive services is to make sure your doctor is writing the order and/or billing the insurance carriers with “routine screening”, “preventive care” procedure/ diagnosis codes. We advise our clients and members to always double check with the provider to be sure that the order has been written properly before having the services done. This will insure that you receive the maximum benefit and the care will be covered at 100%.
If your doctor is treating you for a specific condition or is ordering testing to rule out/diagnose a condition, those services may be billed as diagnostic, which are not considered preventive and will be subject to your plan’s deductible and co-insurance.
If you receive a physician’s bill or an Explanation of Benefits from your insurance carrier for these services and you believe it should have been covered at 100% (due to preventive care guidelines) ALWAYS contact the carrier to find out why. It may be that the physician’s order was not written with the proper preventive codes or billed to the insurance carrier incorrectly.
