This Article is courtesy of LanierUpshaw, a FCSA Marketplace partner – May 25, 2019
Did you know treating chronic conditions accounts for 86% of the nation’s health care costs, and the majority of these conditions can be avoided or better controlled with proper preventive care? The Affordable Care Act (ACA) mandates health plans cover the cost of preventive care, at no extra cost. Then how did you still get a bill from your doctor after a recent preventive visit? These guidelines will help ensure you are able to approve any costs that may come from a preventive care visit before they are performed and billed.
What is preventive care?
While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health. Examples of preventive care may include the following:
- Physical examinations
- Health screening
- Lab tests
- Counseling
- Immunizations
If during the course of a preventive care visit, your doctor completes additional tests, biopsies, etc, this could cause yourpreventive care visit to become a billable event.4 Steps to Avoiding a Surprise Bill from a Preventive Care Visit?
- Stay Within Your Plan’s Network. ACA coverage of preventive care relies on the utilization of providers inside your plan’s network. If you see physicians outside of your network, free preventive care cannot be guaranteed.
- Be Clear That Your Visit is for Preventive Services. Tell your doctor that this visit is covered by your carrier under preventive services when you schedule your appointment and again the day of your visit. Require your approval on any costs that may be incurred before additional tests, labs or procedures are performed.
- Be a Knowledgeable Consumer of your Medical Coverage. Bring a list of the covered preventive services with you to your appointment and discuss with your care provider. A list of preventive care benefits can be found at https://www.healthcare.gov/coverage/preventive-care-benefits/.
- Lab Tests May Be Preventive as Well. Make sure you are utilizing lab facilities that are also in your plan’s network. When preventive and in network, many labs are no cost to you as well.
What’s next?
Be prepared and informed for your next preventive care visit. Talk to your company’s HR professional, visit your carrier’s website or call the hotline found on your insurance card to discuss. Take the time to be an educated consumer of your medical benefits and keep your hard-earned dollars in your pocket whenever possible.
