Unexpected Medical Bills Don’t Make Good Surprises

Understanding your high deductible health insurance plan

Remember the days of paying a $25 copay for every office visit and that was all you were personally responsible for?  With the increasing number of high deductible health insurance plans out there, it has become increasingly more confusing for patients to figure out what they will be responsible for in regards to healthcare costs.  We hear words like “subject to your deductible”, “preventative care”, “100% covered” with no clear understanding with what to expect when the bill ultimately comes in the mail.  I think the key is in understanding preventative care versus diagnostic care.

Preventative Care

Preventative care in gynecology includes the annual examination physical, lab tests, screenings and other services intended to prevent illness or detect problems before you notice any symptoms.  Because of the Affordable Care Act (passed in March 2010), most health insurance plans cover preventative care at 100% and often you won’t have to pay a cent.  It’s important to check with your health insurance plan to find out what services are included in preventative care as well as to make sure you are visiting an in-network provider.

Diagnostic Care

Diagnostic care involves treating a problem you already have, checking out new symptoms, or following up on abnormal lab tests.  When you receive diagnostic care, you may have to pay out-of-pocket with your plan until you have met your deductible and your co-insurance requirements.

Insurance in Action

That all sounds good, but in practice it can seem a little more confusing.  Let’s look at two patients’ examples to help to clarify.

Sue – During her yearly annual gynecology exam, Sue’s provider orders some lab tests, including a pap test to screen for cervical cancer.  Sue has never had an abnormal pap test.  The pap test is considered to be preventative.  Sue’s pap test comes back abnormal and requires additional testing for HPV through the laboratory.  Although the pap test is a preventative test, the additional testing for HPV is considered to be diagnostic because it’s being done because something was abnormal.  Sue’s visit would still be considered to be preventative care but the additional testing is diagnostic.

Julie – During Julie’s annual gynecology visit, Julie is asked about her periods.  Julie talks to her provider about her abnormal bleeding patterns.  Her periods are becoming heavier and sometimes she bleeds in between periods.  Julie’s provider is concerned about what might be causing the change in bleeding patterns.  To further investigate what is going on, Julie’s provider orders some lab tests and an ultrasound.  Because these tests are being done to follow-up on symptoms that Julie is having, these tests are considered to be diagnostic.  Part of Julie’s visit to her provider is considered to be preventative and part of her visit is considered to be diagnostic because of the symptoms she is reporting.

There are a million (probably more) health insurance plans out there and all plans have different coverage.  Please understand that 100% covered is not the same as 100% free of charge.  If you have specific questions regarding your healthcare plan, please call the number on the back of your insurance card to get more information.

For more information on health insurance in general, click here to watch a quick video.