Common Ground Healthcare Cooperative plans include benefits for two types of preventive care. There is a specific list of preventive care services as defined by the Affordable Care Act that are provided at no cost to you as long as you get them through an in-network doctor. But there are also things that you might consider preventive that are not on this list and could be applied to co-payments, coinsurance and deductibles. The lists are provided below.
WE WANT TO EDUCATE MEMBERS ON HOW TO AVOID SURPRISE CHARGES.
Preventive care has resulted in surprise bills for our members. Deciding what preventive services to receive is between you and your in-network doctor, but it’s our job help you understand your benefits and some pitfalls that have caused other members to pay more than they expected. The resources to the right are full of helpful tips you should review before receiving preventive care. Feel free to print these off and take them with you to the doctor’s office. It may help you avoid a costly charge for a test that’s not highly recommended by the US Preventive Services Task Force.
TIP #1: UNDERSTAND THE DIFFERENCE BETWEEN PREVENTIVE CARE AND DIAGNOSTIC CARE
To avoid surprise charges, it is important to understand that “preventive care” is when you don’t have any history, symptoms or other health concerns about the issue for which they are testing or screening. When you have a history or a health concern, those tests and screenings become “diagnostic” and not preventive because the doctor is trying to diagnose a problem. Diagnostic services are typically covered but they are not covered as a no cost share preventative benefit. They will apply to your benefits (copays, deductibles and coinsurance).
Click here to download a full printable list of what may be no-cost-share preventive health services.
Click here to download a full printable list of what may be no-cost-share preventive care medications.
Preventive health services are only covered at 100% if received from an in-network provider.