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With health reform, many people are now aware that preventive care is covered at 100 percent–meaning there is no out-of-pocket cost to the patient. However, what care is considered preventive? Not all cancer screening is preventive (e.g., lung cancer screening is usually not regarded as preventive). Not all routine blood tests are preventive (e.g., thyroid tests are generally not preventive). Not all ‘screening’ doctors’ office visits are preventive (e.g., total body skin exams by dermatologists are usually not considered preventive). So what is preventive and who decides?
Several factors make a screening, test, procedure or doctors’ office visit preventive and covered at 100 percent. First, the test, procedure or visit is widely accepted by the medical community as effective in preventing disease. Second, the patient fits within the gender, age or other demographic parameters of the preventive care recommendation. Finally, the bill is coded by the doctor’s office and processed by the insurance company correctly. It is important to note that all three should happen to fall under the preventive care label.
One helpful hint would be to print out the shortened list of preventive services from the link above and actually have the doctor check off which ones he or she is going to do and make sure that they follow the parameters of the USPSTF. Another tip is to tell the physician you would prefer your visit to be considered ‘preventive’ and coded as such.