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Is your wellness care covered by your insurance plan?

Friday, May 06, 2011

Wellness Care is your first line of defense for early diagnosis and treatment of medical problems. The insurance industry has radically changed coverage guidelines for these services.

In this new world of Healthcare Spending Accounts and Annual Wellness Screening Coverage, how do you determine if your insurance company will pay for these services before your appointment? try the following checklist.

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Wellness care insurancEcoverage checklist

Does not apply to Medicare or medicaid

We have created this checklist in order to help you check your benefits before you have your annual physical.Please bring this to your appointment so we can help you determine which tests are performed or ordered as part of your preventative care.

You may not realize it, but most insurance plans change their coverage guidelines every year. These changes are often in the small print of your benefits book. If you do not check your benefits at every wellness exam, you may be at risk for higher out-of-pocket expense. These tests may be covered under traditional insurance, Healthcare Spending Accounts (HSA) or Flexible Healthcare Spending Accounts (FSA).

Questions to ask your insurance company

"Is __________covered as part of my annual wellness exam?"

"How frequently is this covered, one per year? Every 2 years?"

NOTE: You may or may not need the "codes" to give to your insurance company.

NOTE: The CPT code is for the insurance company to identify specific tests. The ICD9 code billed for a wellness exam is usually V70.0.

Common tests ordered

  • Wellness exam
  • Labs
    CBC CPT code - 85025
    Cholesterol CPT code - 80061
    Lipoprofile (special cholesterol) CPT code - 83704 and 82456
    Basic Metabolic CPT code - 80048
    Comprehensive Metabolic CPT code - 80053
    TSH (thyroid) CPT code - 84443
    Vitamin D CPT code - 82306
    Urine test CPT code - 81001
    PSA (men only) CPT code - 84153
    Pap Smear (women only) CPT code - 88175
    "Are any other labs covered?"
  • Chest X-ray CPT code - 71020
  • EKG CPT code - 93000
  • Any immunizations
  • Bone Density test CPT code - 77080
  • Cardiac CT Scoring CPT code - 75571
  • Ultrasound screening for:
    Carotid Disease (Carotid IMT) CPT code - 0126T
    Abdominal Aortic aneurysm CPT code - 76705
  • Colonoscopy
  • Mammogram

"Do I have additional restrictions on my Wellness coverage?"
(For example, a limited amount of money to spend)

Bring this information to your appointment. Thiswill be very helpful for you and your Physician to decide which screening exams to perform and hopefully save you from potential billing headaches.

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