Preventative Health Services

One of the best ways to manage health care costs is to focus on lifestyle. As we have discussed, healthy choices that minimize inflammation, reduces chances of getting chronic diseases. That is one reason that paleo diets have been embraced and promoted by many doctors.

Another pro-active step in managing health care costs is to take advantage of preventative health services. That is one item of value in the Affordable Care Act is the inclusion of preventative screenings in ALL insurance coverage.F

This means regardless of your deductible, the service is free. No co-pay or co-insurance.

Preventative Services include wellness visits for women and babies; procedures and tests such as mammogram, blood pressure and cholesterol screening. There is a long list of screenings and vaccines that are provided “free of charge”. For a complete list, look at www.healthcare.gov and the tab Preventative Care Benefits.

For those 65 and older and on Medicare, the Affordable Care Act also includes preventative care screenings. Some are new additions such as annual Wellness Visits. The list of services provided by Medicare can be found at www.medicare.gov under the Preventative and Screening Services tab.

Be sure you review eligibility of services. Some screenings have age restrictions and high risk factor requirements. Be sure you have a comprehensive discussion with your doctor AND the billing department before doing any testing.

While preventative care should not have charges – there are loopholes. Be aware of problematic areas. Preventative care is free IF you are in net-work. All participating physicians and labs must be in the network. For example, the doctor performing a colonoscopy may be in the network, but if the anesthesiologist is out of network. You will pay that bill out of pocket.

You may also receive a surprise bill if a preventative test reveals something suspicious that the doctor needs to send to a lab for testing. Colonoscopy Screening is a good example again. If a person goes in for a screening and they find a polyp that they biopsy, the coding can be changed from ‘preventative’ to ‘diagnostic’ and charges may result. The practice varies by insurer.

If you get billed for a preventative procedure that you thought was fully covered, contact your insurer for an explanation. Then you may contact your state insurance department’s consumer assistance program. In response to consumer complaints, some states have passed laws requiring insurers to code colonoscopy as a preventative procedure that is not subject to a deductible, as long as the test was originally intended as a screening.

Being a wise consumer of preventative services is important to protect your pocketbook.
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