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Health and wellness

Screenings vs. diagnostic medical tests: Why did I get a bill for that?

A wellness visit or annual physical is also considered preventive healthcare, and may be covered at 100 percent under your health plan. But did you know if you schedule a physical and then bring up a health issue, you might get charged for a regular office visit? That’s one reason it is important to know the difference between preventive care and diagnostic tests.

Preventive screenings look for diseases or conditions before there are symptoms or signs. These usually are done at certain ages. The idea is that if you catch and treat a disease early it will be easier to manage or eliminate. Because preventive screenings are so important in protecting your health, many of them are covered at no cost to you under your medical plan.

Diagnostic tests are done when you and your doctor know you have a health problem and you need to know the cause. For instance, if you have chest pain, your doctor may order a number of tests to find out why.

As an example, women get regular mammograms at no cost to them as a preventive screening. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. However, if her doctor schedules a follow up mammogram six months later to re-examine that change, it would be used to diagnose a symptom, so it wouldn’t be preventive.

Three ways to save on preventive healthcare benefits

  1. The easiest way to find out what preventive screenings your health plan covers is to call the customer service number on your member ID card before you go to the doctor. You can find out what screenings are available to you based on your age.
  2. If your primary care doctor suggests a “screening” you think might not be covered, ask if there is a reason for the test to be done. You may need the test, but if you have a symptom, it will be diagnostic.
  3. Make sure you visit doctors who are in our network to get free or low-cost preventive healthcare. If your preventive screenings turn up a health issue and you need to see a specialist, make sure your doctor recommends a specialist who is also in our network. You can find out if a doctor is in our networks by using our find care tool or calling customer service.