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 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:
Laboratory blood tests for diagnosed high cholesterol and diabetes.
The preventive schedules Highmark uses are based on the federal mandates under the Patient Protection and Affordable Care Act (PPACA) from the United States Preventive Services Task Force (USPSTF), and the immunization schedule from the American Academy of Pediatrics’ Bright Futures initiative and the Centers for Disease Control and Prevention (CDC). State mandates are also followed.
Both types of screenings may be covered at no cost to our members. In most cases, there is no cost for preventive screenings. However, cost-sharing practices like copays, deductibles, and coinsurance may apply to diagnostic care received at an appointment, even if it’s a preventive office visit. It’s best to check with your doctor, contact us through the member portal, or call the Member Service number on the back of your member ID card.
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.
This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. It also does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.
®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.
Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.
West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit our website to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.
Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.
Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
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