Why did I get a bill for a preventive care visit?
A preventive care visit with your doctor focuses on your overall health and how to stay healthy. But a preventive visit may turn into an office visit that costs you money. Learn why.
Overview
When does a preventive visit become an office visit?
A preventive care visit is different from an office visit:
- The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network.*
- The purpose of an office visit is to discuss or get treated for a specific health concern or condition. You may have to pay for the visit as part of your deductible, copay and/or coinsurance.
If you schedule a preventive care visit and ask your doctor about a specific health concern or condition, your clinic may code and bill the appointment as an office visit.
If you want to know about costs, ask your doctor for an estimate of fees before you visit. You can also call the number on the back of your member ID card. The list below shows what services are covered during a preventive visit.
What can I discuss at a preventive visit without getting charged?
During your preventive care visit, your doctor will look at your health risks and talk with you about:
- Your current health
- Your family health history
- Past illnesses and surgeries
- Risks you may have for specific conditions
- How to maintain a healthy lifestyle
The difference
A preventive care visit
Your plan covers 100% of these services
- Check your weight, height, temperature, blood pressure and pulse
- Listen to your heart and lungs
- Check your ears, eyes, throat, skin and abdomen
- Various immunizations
- Various cancer screenings, such as for breast, colorectal, cervical and prostate cancer
- Certain blood tests to check such things as cholesterol or blood sugar
An office visit
You must pay for these services
- Discussing or getting treatment for a specific health concern, condition or injury
- Lab work, X-rays or additional tests related to a specific health concern, condition or injury
Coverage
Proper preventive care is important to help you live a longer, healthier life. A preventive checkup can help prevent disease before it starts and detect problems early, before they cause serious illness.
How often and what kind of preventive care you need depends on your age, gender, health and family health history. Look over the guidelines for men, women and children in our preventive care recommendations (PDF).
The preventive care that Blue Cross and Blue Plus plans cover varies by plan. Call the number on the back of your member ID card to find out what your plan covers.
Find a doctor and schedule your preventive care visit today.
SVG
Find care
Search for in-network doctors and providers in your area. Log in for current plan coverage.
This is general information about how plan benefits work. Review the Summary of Benefits and Coverage and your specific health plan benefit booklet for information about how your plan works.
It’s up to you to always check if your provider is in your health plan network before you receive services. Not all providers are in every network. You may pay more or for all of your healthcare costs if your provider is out of your network or does not have a contract with Blue Cross (this is called a non-participating provider). You can verify if your provider is in your network by calling customer service at the number on the back of your member ID card.