Reports are surfacing of patients who went to their doctor for a checkup and later received a bill for services they thought were free, based on the new healthcare law. The confusion stems from the fact that while plans purchased through the healthcare marketplace are required to cover certain preventive and wellness services at no additional cost to the patient, diagnostic services are not covered at no additional charge.
Preventive or Diagnostic—What’s the Difference?
Put simply, preventive care helps prevent a person from becoming sick, while diagnostic care is used to identify the cause of existing symptoms and/or used to treat an existing illness. So, for example, if your doctor wants you to have a mammogram as a preventative measure due to your age, even if you have no symptoms, this is considered preventive care. If, on the other hand, you have symptoms, such as a lump in your breast that prompts your doctor to order a mammogram, this is considered diagnostic care.
Examples of free preventive services include:
- Blood pressure screenings
- Diet counseling for adults at higher risk for chronic disease
- Depression screenings
- Certain immunizations, including diphtheria, tetanus, pertussis (whooping cough), MMR, influenza and polio
Doctors often perform several different exams, screenings, and laboratory tests in a single visit, but it is possible that some of these may be covered at no additional cost, while others are not. In order to avoid unexpected and burdensome medical bills, it’s important that you understand which specific services are covered with no additional out-of-pocket costs, and which are not.
The Certified Insurance Agents at Benefit Packages can help you understand the difference between preventive and diagnostic services, as well as what benefits all plans must cover under the new law. Call us today for more information.