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Avoid surprises during preventive care visits

Answers to common questions

This article was last updated on April 28, 2020. 

** Preventive care plays an important role in your overall health. However, seeking preventive care during the coronavirus pandemic may look different than it has before. Please be sure to contact your provider or visit their website before your appointment to learn about special procedures that might be in place. ** 

 

We all know how important it is to have a personal doctor and get regular preventive checkups. It’s even been proven that regular preventive care leads to better health outcomes External Site in the long run.

But what is preventive care? And what should your benefits cover? It’s important to feel informed and empowered when you go into your next yearly checkup to avoid unexpected costs down the road.

Our most frequently asked questions about preventive care

  1. What are preventive care visits?

    Preventive care visits are performed in the absence of a medical condition or symptom. That’s just a complicated way of saying preventive services help prevent sickness or disease. Your doctor can help identify health conditions in their early stages when they are easier and less costly to treat. Preventive exams can include things like standard immunizations, blood pressure screenings, blood work, and depression screenings.

  2. Are preventive visits free?

    Almost all preventive services are covered at no cost to you if you have medical insurance. As always, be sure you log in or register for myWellmark® Opens New Window to know the basics of your specific health plan and how it works. For example, some plans require you to see the provider you've chosen as your personal doctor for preventive care visits to be covered at 100 percent.

  3. How often are preventive visits covered?

    Again, you should check your benefits for specific coverage details. Most Wellmark Blue Cross and Blue Shield plans cover one preventive exam at zero member cost-share each annual benefit period. That means you don’t need to wait 365 days from one preventive exam to the next. For example, if your annual benefit period runs from January to December, you can have a preventive exam in November and again in April.

  4. When does a preventive exam turn into a medical visit?

    Sometimes, there is confusion about when a preventive visit turns into a medical visit. If your doctor discovers something during your exam, he or she may order additional testing. If this results in a diagnosis other than preventive care, the appointment could turn into a medical visit where cost-share may apply. This may lead to out-of-pocket costs for you that you weren't expecting.

  5. What is covered at my visit?

    Before your visit, check your benefits to understand what will and won’t be covered at your checkup. Wellmark has outlined a list of common preventive services PDF File that are covered under the Affordable Care Act (ACA). No matter what your specific plan covers, these are great screenings to keep in mind and discuss with your doctor:

    • Annual wellness examination
    • Colorectal cancer screening
    • Depression screening
    • High blood-pressure screening
    • Immunizations

At the end of the day, make sure you know the basics of your health plan and how it works. Don’t leave it up to your doctor to know the ins and outs. If you wait until you're in the exam room to ask questions about billing or costs, you could be in for a surprise. Call ahead and speak to a billing specialist to clear up any lingering questions you have about preventive services.

Wellmark members can call the customer service number on the back of your ID card or log in to myWellmark Opens New Window. You can even download the mobile app Opens New Window for easy, on-the-go access to tools and resources to make health insurance even easier.