The services you receive from your health care provider get coded either as preventive or diagnostic care. Why is this important? This coding could determine whether your service is covered at no cost by your health plan or if it will be subject to your deductible and/or co-pay.
Maximize the benefits of your health plan by knowing the difference between preventive and diagnostic care.
Preventive care is a proactive approach to your well-being that can help uncover health issues before symptoms appear and possibly prevent them from worsening. Early detection is crucial for the best outcome when dealing with health conditions.
Preventive care often includes:
For more common preventive care services, download a Preventive Health Checklist for Adults Ages 19+.
Diagnostic care involves the diagnosis, monitoring and treatment of symptoms, risk factors or health conditions, including illnesses and injuries. In this case, the health care provider seeks to diagnose or treat an existing condition.
Common types of diagnostic care can include:
| Preventive Care Examples | Diagnostic Care Examples |
| Routine cancer screening (without existing symptoms or risk) | Radiation for cancer treatment |
| Diabetes Screening (without existing symptoms or risk) | An office visit for diabetes management |
| Flu immunization | Treatment for flu symptoms |
| Routine annual checkup | X-ray and cast for a broken leg |
Save money. When you seek preventive services covered by your health plan, let your health care provider know when you schedule the appointment. Then, monitor your explanation of benefits (EOB) statements to verify that the services were submitted with accurate information. When coded correctly, preventive services can be provided at no cost to you.
Promote your well-being. Taking advantage of preventive services can help identify issues early, potentially improving outcomes. Familiarize yourself with your health plan to know what’s available to you.
Maximize your benefits. If a medical service such as a vitamin D test is denied when coded as preventive, you may ask your health care provider to resubmit the claim as diagnostic. If approved, the service could then be applied toward your deductible.
We’re your advocate along your wellness journey through all seasons of ministry. Looking for a health plan that aligns with your biblical values? Explore health plans designed with ministry in mind. For more information, contact us at Insurance@GuideStone.org or 1-844-INS-GUIDE (1-844-467-4843), Monday through Friday, from 7 a.m. to 6 p.m. CT.
GuideStone® welcomes the opportunity to share this general information. However, this article is not intended to be relied upon as medical advice, diagnosis or treatment.
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