It’s a new year and you may have made a resolution to take better care of your health.

Preventive care makes this possible. It will help your doctor detect health problems before you have symptoms and head off sickness. Certain routine preventive care services are covered with no out-of-pocket costs in many BCBSNC plans. If you have a “grandfathered” plan (plans in effective prior to March 23, 2010), preventive care may not be covered at 100% (i.e., there would be out-of-pocket expenses). If you’re not sure if you are eligible for these 100% covered benefits, call the customer service number on the back of your Identification Card or look in your benefit booklet . As you schedule a yearly visit to the doctor’s office, here are three easy things to remember in order to avoid a surprise bill.


1. What’s covered under preventive care?

Certain screenings and tests like mammograms, colorectal screenings, cervical cancer screenings, well-baby and well-child visits, counseling, and some immunizations are all covered at 100%. A full list of the covered services for eligible members can be found here . When making your appointment and when you are at the doctor’s office, say that you want federally designated preventive services that are covered at 100%. You can, of course, get other services. But it’s important to know that some procedures and tests are not covered at 100%. These include urinalysis, vitamin D tests, and hormone tests among others. For a complete list of covered preventive care services, please visit here.


2. What isn’t covered?

Often when the doctor is done with your physical, he or she will ask if you have any more questions. Or, perhaps you remember that nagging shoulder pain you’ve been having. Once the conversation turns away from preventive care, you’re in a different type of visit – and that can include out-of-pocket expenses. Doctors are required to code all the services they provide. Since your shoulder pain is not covered as preventive care, they will not code it as such. Because of that, you will likely have out-of-pocket costs for any advice or care beyond what is covered as preventive care, unless you have met your out-of-pocket maximum.


3. How should you pick a doctor for preventive care?

Preventive care is only covered without any out-of-pocket costs if the doctor is in your plan’s network. If you go to an out-of-network doctor, certain preventive care services are not covered at all. And for those that are, you will also end up paying more as consumers are responsible for a bigger part of the bill if they go outside their plan’s network. Also be sure that any lab work is sent to an in-network lab. Use our ‘Find a Doctor’ tool to find doctors and labs that are in-network.

If you have questions about a bill you receive from your doctor’s office after you go in for preventive care, compare the bill to the Explanation of Benefits that you receive from us. If you still have questions, contact us or your doctor’s billing office for answers.

Leah Mararo

About Leah Mararo

Leah Mararo is a Communicators Coordinator at BCBSNC. Leah loves her job because she likes guiding our members through complicated benefits information with simple, effective communication pieces. When she’s not at work, Leah enjoys spending time with her family, playing table tennis and reading.

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