Preventive services and other medical services are different. And they may happen during the same doctor’s office visit or separate visits.
Preventive services may include an exam, blood pressure check or recommended vaccines. Depending on your specific health plan, preventive services may be covered without a copay or deductible.
Other kinds of medical services include checking symptoms and treating medical conditions. The doctor determines if the services you receive are billed as preventive or medical. Claims are paid based on what the doctor’s office submits.
Preventive and medical services may be billed separately even if both kinds of services are done at the same visit.
For example, if your doctor discusses a health problem during your preventive office visit, he or she may bill part of the visit as preventive and part as a medical office visit. Copays and deductibles would apply to the medical services.
If your doctor spends most of the visit on health problems instead of preventive care, the whole visit may be billed as medical. Copays and deductibles would apply.
You can call customer service at the toll-free number on the back of your member ID card to talk about how your benefits apply and get the most up-to-date list of covered preventive services.