These are usually routine, preventative visits that health plans typically cover 100% (no copay, coinsurance or deductible amounts). Outpatient procedures performed during or immediately after the wellness visits however are not necessarily covered 100% by your insurance. We have outlined a few key points to try and help you better understand your health benefits.
Diagnostic vs. Screening
Physicians will sometimes schedule certain outpatient services or procedures during a wellness visit. Many patients assume that these are screening (preventative) services when that is not necessarily the case.
For example, if you complain of heartburn during a wellness visit, the lab test would be ordered based on symptoms observed and is therefore diagnostic. Typically these charges are subject to copays, coinsurance or deductibles.
If tests are done strictly for preventative reasons and not in response to displayed symptoms, they will actually result in less financial responsibility to you as a patient. The coverage varies by insurance provider.
Wellness Visits & Billing
The reason why a test or a procedure was ordered determines whether it is coded as a screening or diagnostic service.
Coding of Medical Services
When you consult with your health plan about why certain procedures were not covered, they may talk about how it was coded. There are strict definitions for diagnostic and screening services and all are coded according to the physician’s documentation. If you believe a service has been coded incorrectly, please bring it to our attention so we can investigate and correct the matter if necessary. On the other hand, please keep in mind that we cannot change the coding of medical services simply to reduce your personal liability for the particular claim. Thank you for your understanding.
We want you to be more informed and have the best possible experience while receiving quality services from our providers. We strive to offer excellent financial services to you as well. Our goal is that you clearly understand the services you receive, your benefit plan, and your financial responsibility.
If you have any questions, please call the Business Office at 320.634.4521 and ask to speak to a Patient Account Representative. We will be glad to assist you.