Preventive care refers to services or tests that help identify health risks, and it’s covered at no cost to plan members when received in-network. For example, preventive care includes screening mammograms, annual wellness exam/physical and immunizations. In many cases, preventive care helps a patient avoid a serious or even life-threatening disease.
If an annual preventive visit includes discussion or treatment of a specific health issue, plan members may be required to pay a copay or coinsurance for a regular office visit. Claims are processed based on the diagnosis submitted by the provider, so it is important for the provider to file the claim as preventive to avoid unexpected member charges.