Preventive vs Diagnostic Service FAQ
To understand whether a service is preventive or diagnostic, it’s important to discuss your ongoing care with your physician. You can also call the Member Service number on the back of your member ID card if you have questions about which services are fully covered. Diagnostic services may require a copay, coinsurance, or deductible — as indicated by your health plan.
Preventive care finds health problems you may not know you have - before you have symptoms. Diagnostic care is about finding the cause of a symptom or treating it. An annual well visit is considered preventive care. But if you talk about a symptom your care can become diagnostic. In-network preventive care is covered by your plan; however, you may still have fees for diagnostic care.
Preventive screenings are routine tests that can help you stay well by finding or detecting problems early when they’re easier to treat. They’re administered when you don’t have symptoms or a current diagnosis of disease. For example, Pap smear screenings can be done annually or every three years to detect cervical cancer.
Preventive care also includes services like:
- Annual wellness visits.
- Immunizations like flu shots.
- Certain lab tests like cholesterol checks.
Diagnostic services and tests are prescribed by a doctor when you’ve been diagnosed with a disease or have symptoms that need to be evaluated. These services may also include test results that may have been abnormal or not in a normal range. For example, if you’re experiencing cervical pain or bleeding, your doctor may prescribe a more comprehensive diagnostic Pap smear test. This is different than a preventive Pap smear screening.
Diagnostic care may also be given during your preventive care visit. For example, during an annual wellness visit, if your doctor is treating a chronic condition, they may want to investigate further by ordering additional tests. These may require a copay, coinsurance, or deductible. Other types of diagnostic services can include:
- X-rays.
- Ultrasound examinations.
- Laboratory blood tests for diagnosed high cholesterol and diabetes.
