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Preventive vs. Diagnostic Care

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Preventive vs. Diagnostic Care
Scroll to learn more

Preventive vs. Diagnostic Care

What’s the difference and can I be charged for both in the same visit? At first glance, a physical and an office visit may seem like the same thing. It’s important to understand the differences between the two, because it may affect your costs.

Preventive Care Visit (or Physical)

Diagnostic or Office Visit

Your plan covers 100% of these services with in-network providers.

You may be charged for these services depending on your benefits.
Routine health care that is focused on preventing illnesses, disease or other health problems.  It could include:

  • A review of your general health and well-being
  • Physical exam
  • Check-ups
  • Screenings
  • Immunizations
  • Counseling and interventions
  • Recommendations about general health like diet, exercise, disease screenings or well-being

Preventive care depends on your age and other risk factors.

Health care appointment that is focused on existing health concerns:

  • Discussion of a concern, condition or injury and your treatment options
  • Lab work, X-rays or additional tests
  • Prescription medication to treat the problem

Can one appointment be considered both?

Based on the definitions above, you may be wondering if the same appointment can be considered both a physical and an office visit? The answer is, yes.

What does that mean for you?

While combining a preventive physical and an office visit will save you time by eliminating an extra appointment, it may also affect your costs. On occasion, one appointment can meet the requirements for both types of visits. Providers legally must bill your visit based on both the reason you initially scheduled the appointment and what is done during the appointment.

For this reason, it’s important to understand your benefit information and what costs you can anticipate.

Call To Action

Understanding Your Benefits

If want to learn more about your insurance coverage and costs, review your Summary of Benefits and Coverage. You can also call our Member Services team Monday through Friday, 8 a.m. – 5 p.m. at (608) 828-4853.

Summary of Benefits and Coverage