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Free Preventive Services: Take Advantage! (Part 2: Adults)



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By Martine G. Brousse (not AI!)

"The Medical Bill Whisperer"

Patient Advocate, Certified Mediator

AdvimedPro

 

July 9, 2024


Since 2010 and the Affordable Care Act, insurance companies must cover a number of services at no cost to you and your family. These are “preventive” services with a main objective to shift the current state of our healthcare system from curative and reactive to preventive, and saving lives, money and resources. So, are you taking full advantage?


A. Basics


1.     Does your plan qualify?

·       If you bought your policy yourself through the ACA or Obamacare exchange, or through an insurance agent, it should qualify.

·       If your employer bought the policy through an agent or on the open market, it should qualify

·       If your employer’s plan is ERISA, or self-funded - meaning they are a larger company that determines the terms of their own policy and pay their own claims while the insurance only acts as administrator - it is not required to follow those guidelines but it likely does too.

·       Government-issued policies such as Medicare, Medicaid and Tricare have their own set of rules, and are not specifically included here.

2. Do you qualify?

Are you a child, or some form of an adult with such a plan ? If yes, you qualify !!!


B. What it means for your wallet


Your insurance plan must cover a range of medical services without charging members a deductible, copayment or coinsurance, even if they have not yet been met.


Services can include:

·       Documenting your health habits and history

·       Assessing your health status

·       Services that improve your health by preventing diseases and other health problems

·       Screening tests to detect diseases early when they may be easier to treat

·       Education and counseling to help you make informed health decisions

·       Physical exams, tests, scans

·       Setting health goals

·       Advice and support on dealing with an issue or condition


C. For all Adults

 

1. Clinical screenings

·      Blood pressure, cholesterol, aspirin use, Diabetes, Hep B and C, HIV, STDs, statin, TB

·      Immunizations and boosters

2. Cancer prevention screenings

·      Colorectal (lab, colonoscopy

·      Lung (LDCT (low-dose helical computed tomography)

3.    Mental health assessments

·      Depression

4.    Lifestyle evaluation, education and counseling

·      Alcohol misuse,

·      Diet & obesity

·      Tobacco cessation

·      Fall prevention

 

D.  Especially for men (in addition to above)


·      Abdominal aortic aneurysm screening

 

E. Especially for women (in addition to above)


1.     Before Pregnancy:

·      Contraception: Barrier methods, like diaphragms and sponges, Hormonal methods, like birth control pills and vaginal rings, Implanted devices, like intrauterine devices (IUDs), Emergency contraception, like Plan B® and ella®, Sterilization procedures, Patient education and counseling

2.   During Pregnancy:

·      Folic acid supplementation

·      Gestational Diabetes screening

·      STD and Hep B screenings

·      Preeclampsia prevention and screening

·      Rh incompatibility screening

3.   New mothers

·      Maternal depression screenings

·      Breastfeeding support, counseling and access to devices and supplies

4.   All women

·      Bone density (post menopause)

·      Breast cancer genetic test counseling (BRCA) for women at higher risk

·      Breast cancer screenings (mammograms) and chemo prevention counseling (high risk)

·      Cervical cancer screenings (Pap smear)

·      Domestic violence screening and counseling

·      Sexual health counseling

·      Urinary incontinence screening

·      Well-woman visits: Documenting your health habits and history, getting a physical exam, setting health goals

 

F. Helpful tips


1.   Preventive care services are only free if performed by an In Network provider. Out of network services will be covered… out of your pocket… or not at all. You can find a list of In Network providers on your plan’s online portal or by calling your insurance.

2. Always mention “preventive care visit” when making an appointment to alert the office to properly code the services as “preventive”. Remind the Dr too at the time of the visit.

3. “Preventive” means one-time assessment. Should a new issue be detected, and a treatment prescribed, that would fall under the “diagnostic” or “therapeutic” terms of coverage. Let’s say you get your “physical” exam but it turns out you need a treatment, only the initial visit would be at no cost to you.

4. There are a number of resources for more details:


G. Save money ... and your health!


  • Screening tests and checkups can find health problems early, when they may be easier (and cheaper!) to treat. 

  • Preventive services can keep new health problems from worsening or becoming chronic, helping you avoid costly medical bills down the road. 

  • Get peace of mind. Regular checkups are a chance to share concerns and ask questions about your health — and get support and guidance from a doctor or health care professional.

        

 

Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.

 

(424) 999 4705 - F (424) 226 1330

@martine brousse 2024 @ the medical bill whisperer 2024

@themedicalbillwhisperer 2024

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