Understanding benefits and preventive services

Prevention can make it easier to stay healthy and ultimately reduce healthcare costs. But there are lots of misconceptions about what prevention is and why it is necessary.

We are going to explain what services are covered by HealthPartners’ preventive services and explain the difference between a preventive visit and an office visit. We may even clear up common misconceptions about preventive services.

What are preventive services?

Preventive care services are included in what you already pay for medical insurance. This implies there aren’t any out-of-pocket costs so long as you receive preventive care services covered by your plan from a physician or clinic in your network.

How does HealthPartners define what a preventive service is?

Health plans, including HealthPartners plans, don’t specify which services are considered preventive and as an alternative must comply with the preventive care principles set forth within the Inexpensive Care Act (ACA). This ensures that medical insurance firms provide coverage in the identical way.

The ACA primarily defines preventive services as those rated A or B below United States Preventive Services Task Force (USPSTF) guidelines.. These include things like:

When HealthPartners receives a claim out of your doctor, they check how the service provided is coded into the USPSTF. Codes that meet a rating of A or B are eligible for the Preventive Care Profit. Codes that don’t match are covered by other parts of your health plan benefits, resembling outpatient visit benefits or laboratory benefits.

A preventive visit is generally a visit to your primary care physician to evaluate your health, even when you feel well. During these visits, you’ll receive a physical examination and any screening tests which can be beneficial based in your age and gender. Preventive visits help discover health problems before they change into a long-term condition and help make certain you are doing what it’s essential to do to remain healthy.

Preventive services often happen during preventive visits. But preventive visits can also include care beyond preventive services if it is expounded to maintaining health. In other words, one doctor visit can lead to two or more forms of care which can be covered in a different way in your plan.

What’s the difference between a preventive visit and an office visit?

Prevention visits normally happen if you feel well, while office visits are scheduled if you need assistance diagnosing symptoms or treating a selected condition. Each may cover services resembling exams, vaccinations, and screenings, but they’re covered by other medical insurance.

Let’s undergo an example

Bob schedules a preventive visit at his local HealthPartners clinic. During this visit, she talks to her doctor about how she is feeling and undergoes an annual physical examination. Bob’s blood pressure has been barely higher over the previous couple of visits, so his doctor recommends getting some blood tests to see what is going on on. He also has a history of gout, so his doctor checks this out and completes a prescription that helps prevent gout flare-ups. After talking to the doctor, Bob stops on the lab for a blood draw and leaves feeling he has every little thing he needs to remain healthy.

Just a few weeks later, Bob receives a Benefits Explainer from HealthPartners that shows how the visit was covered by his insurance and how much (if any) he has to pay out-of-pocket.

1. Bob’s physical and general screenings (resembling blood pressure checks) are preventive services that fall under USPSTF guidelines, in order that they were 100% covered by his Preventive Care Plan benefits.
2. Bob’s lab work just isn’t considered a preventive service as his doctor beneficial a blood test based on a possible diagnosis. The prices were covered by the non-preventive laboratory allowance of his plan.
3. As Bob has previously been diagnosed with gout, this a part of the visit can be not considered a preventive service because it is an ongoing condition. This was covered by the outpatient visit profit under his plan.
4. In consequence, Bob has some out-of-pocket expenses for some lab and office visits.

Common misconceptions about preventive services

There could be a number of confusion about what services are considered preventive care. We’ll walk you thru a number of the most typical misconceptions we see to make it easier to higher understand the benefits of HealthPartners preventive care.

Misconception 1: Because I scheduled a preventive visit, it should be billed as 100% preventive care

It is not at all times like that. The older you might be, the less likely you might be to get a 100% preventive visit. As you reach certain life stages, conversations together with your doctor about pre-existing illness, family health history, or current symptoms change into more likely and can turn preventive visits into regular office visits.

Misconception 2: Annual screening is at all times a preventive service

It depends. Remember, for something to qualify as preventive service, it will need to have occurred before the issue was identified. Thus, services resembling a colonoscopy or mammogram may or is probably not considered preventive services, depending in your health condition.

For instance, if an individual gets a mammogram during their annual breast cancer screening, it’s preventative. But when something abnormal is found and further scans or additional care are needed, these services aren’t any longer considered preventive and you could incur some out-of-pocket costs.

Misconception 3: 2D and 3D mammography are preventive services

It depends. All employer and individual HealthPartner plans include 2D and 3D mammography as a preventive service. But Medicaid and Medicare plans only cover 3D mammography when medically essential.

Misconception 4: All blood tests are covered as a preventive service

It depends. Routine blood tests for conditions resembling hypertension, high cholesterol, and diabetes will not be considered preventive services. This goes back to the concept for something to be preventive, it should be previously unknown. As we saw with Bob’s example, once the condition is diagnosed, members might want to use other areas of their insurance, which can involve some out-of-pocket costs.

Misconception 5: You do not have to attend a full three hundred and sixty five days to your next annual checkup or healthy baby scan

Real. To be covered by preventive services, most plans don’t require annual checkups or exams for healthy children at the very least three hundred and sixty five days apart.