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Monday, March 07, 2011

If "Preventative Services" are Free, How are They Defined?

The Patient Protection and Affordable Care Act (the law behind Congressional Healthcare Reform also known as PPACA) mandates that all preventative services be delivered at no cost to the insured patient (that's you if you participate in our health plan).  So since most everyone at some point or other has been burned by the specificity of how an insurance carrier defines covered services, the big question so far as been, "What exactly is considered a preventative service?" 

Here from the Blue Cross Blue Shield of Tennessee PPACA flier "Preventative Services" is how BCBS defines these services. 

All Members

• One-a-year preventive health exams. More frequent preventive exams are covered for children up to age 3

• All standard immunizations adopted by the CDC

• Screening for colorectal cancer (age 50 – 75 ), high cholesterol and lipids, high blood pressure, obesity, diabetes and depression

• Screening for HIV and certain sexually transmitted diseases, and counseling for the prevention of sexually transmitted diseases

• Screening and counseling in primary care setting for alcohol misuse and tobacco use; tobacco cessation counseling in the primary care setting will be limited to eight visits per year

• Dietary counseling for adults with hyperlipidemia, hypertension, Type 2 diabetes, obesity, coronary artery disease and congestive heart failure; limited to six visits per year


• Cervical cancer screening

• Screening of pregnant women for anemia, iron deficiency, bacteriuria, hepatitis B virus and Rh factor incompatibility

• Advice to promote and aid with breast-feeding

• Mammography screening at age 40 and over, and evaluation for genetic testing for BRCA breast cancer gene

• Osteoporosis screening (age 60 or older)

• Counseling women at high risk of breast cancer for chemoprevention, including risks and benefits


• Prostate cancer screening at age 50 and older

• Abdominal aortic aneurysm screening at age 65 – 75


• Newborn screening for hearing, phenylketonuria (PKU), thyroid disease, sickle cell anemia and cystic

• Development delays and autism screenings

• Iron deficiency screening

• Vision screening

• Screening for major depressive disorders

Please note that annual limits apply to some: for instance, I have two physicals a year to monitor a personal health condition. One of those will be considered a free preventative health screening, the other will be considered diagnosis-related and applied toward my HDP deductible.
Never neglect your health, but it is always a good idea to have your doctor check with BCBS for coverage before undertaking any potentially expensive procedure. Knowing up front prevents surprises after the fact.

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