2018 Buchanan Hauling Benefit Guide
Know the Difference between Preventive and Non-Preventive Care
Most plans cover preventive care services at 100%, however, you need to understand if your visit will be classified as preventive care or as diagnostic. Use the guide below to help you understand the difference.
Preventive Care
Non-Preventive Care
Mammogram – annually for women starting at age 40, or recommendation Colonoscopy – every 10 years starting at age 50, recommendation Annual physical/preventive care exam – includes height, weight, blood pressure Pap smear – once annually for women who are 18 years of age or older
Patient found lump in breast and doctor recommends mammogram to diagnose condition
Patient has unexplained weight loss and constipation. Afraid it’s colon cancer; schedules colonoscopy
Office visit due to fever and rash
Abnormal Pap smear; returns for second exam. This second exam would be considered non-preventive
Preventive care: Routine annual screenings to “prevent” illness or injury. Non-preventive care: If diagnosed with a condition, some screenings are often considered part of treatment. Be sure to talk to your doctor.
Services covered at 100% under Preventive Care Benefit: • Well child visits/immunizations • Routine adult physical exams • Mammograms • Routine gynecological exams including pap smear • DRE and PSA (Prostate Screening) • Colorectal cancer screening • Labs, pathology, chest x-ray, and EKG (when performed as preventive care) • Be sure your doctor codes the claim as “preventive.”
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