The type of visit you have determines the ways your services are billed because your insurance company covers different kinds of visits at different levels. These levels range from no-cost preventive visits assured under the Affordable Care Act for Healthcare to specialty visits and hospital visits. This diagram presents insurance company’s basic categories of visit type and may help you understand complex medical bills.
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This appointment is meant to focus on the prevention of a disease or conditions and is preformed by your primary care provider.
Preventive visits are usually fully covered by your insurance company. To confirm that you have a specific preventive care benefit with your insurance company, contact them or your online benefit guide at your insurance company’s website.
If your preventive care visit is covered, the insurance company will likely cover 100% of the visit once per year. It’s your annual check-up. This means no copay, coinsurance or deductible will be applied.
Make sure to confirm which tests are included in the benefit as this varies by insurance plan.
The preventive visit does not include follow-up of previously diagnosed medical issues or even current medical symptoms. If you need to have any current symptoms diagnosed or if you wish to have previously diagnosed medical issues reviewed, you will need to schedule a separate visit.
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In a diagnostic visit your provider will evaluate your current symptoms and diagnose accordingly. The provider may order tests for confirmation of diagnosis. Some of the tests ordered may be conducted by a different provider or organization. In those cases and you may receive a separate bill for them.
Your provider may suggest next steps for the diagnosis and these may take place in an emergency room, an urgent care facility, a walk-in clinic, a lab, or your primary care office. Depending on the location, you may have a different copay. Or the tests may be applied to your deductible and/or coinsurance.
To avoid costly surprises, check your insurance benefits for the type of visit or test in order to determine the costs for which you will be responsible.
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Maintenance appointments focus on an existing problem that was previously diagnosed.
Something of a follow-up of a previous diagnostic appointments, the maintenance visit may include a review of the care plan that was previously put into place; it may include lab tests, radiology or specialist visits.
This typically takes place at your primary care office, even if the issue was originally diagnosed elsewhere. Maintenance visits usually require copay, deductible and coinsurance. Again, a good review of your insurance company will prevent surprises and help you plan for costs associated with your maintenance visits.
Click here to read about your insurance company’s claims process after your visit