Preventive Care Vs Diagnostic Care: What's The Difference?

Preventive and diagnostic care describe two types of healthcare you may receive. Both are ways your healthcare providers help you stay as healthy as possible. So, here is an insight into understanding “preventive care vs diagnostic care!”

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Knowing the Difference Matters

It is essential to understand the difference between the two types of care, because during the same healthcare visit, you may receive preventive as well as diagnostic services. 

Although with preventive care you can avail the benefits at no cost for most policyholders, a company can charge you for the diagnostic care services.

Preventive Vs Diagnostic Care

Most importantly, the primary goal of preventive care is to detect health problems before symptoms develop. On the other hand, you are given diagnostic care to diagnose or treat diseases you already have. Preventive care is usually received during a routine physical, while diagnostic care may result if a preventive screening detects some unusual results.

The line between these types of care can be obscured, with the same procedure being classified differently depending on the situation. 

What is Preventive Care?

Preventive care emphasizes evaluating your current health, concentrates on disease prevention, and is an excellent way to help you stay healthy. In other words, you get preventive care when you are symptom-free and have absolutely no reason to believe that you might be sick.

It is a part of routine physical care such as checkups, annual wellness visits, and preventive screening tests. Furthermore, preventive care visits are usually free of cost.

You might hear different names for preventive care visits such as well-care visit, well-adult visit, annual physical exam, and annual wellness visit.

Preventive services are standard and may include:

• Assessing risk factors for chronic diseases like checking levels of blood sugar, blood pressure, and cholesterol.
• Cancer screening tests that are age appropriate
• Checking older adults for fall risks, hearing impairment, and memory loss.
• Administering routine immunizations to prevent diseases such as the flu, COVID-19, or pneumonia.
• Monitoring height and weight.
• Carrying out screenings for depression.

What is Diagnostic Care?

Diagnostic care involves treating or diagnosing a disease you are having by monitoring existing problems, checking new symptoms, and following up on test results that may not have been in the standard range.

Diagnostic care includes services such as ultrasound, radiology, or laboratory tests. In case you have high cholesterol, diabetes, or any other medical condition for which you may have periodic blood tests done, these tests would be considered diagnostic.

Preventive and diagnostic care may occur in the same visit. For instance, during a routine checkup, your doctor may discuss a chronic condition and you may end up with some tests.

Moreover, some tests suggested by your doctor may be preventive (e.g., screening mammogram), and other tests may be diagnostic (e.g., cholesterol check). You will not have to pay anything for many preventive services, while diagnostic services may have a copayment or coinsurance amount that you will have to pay.

Understanding the differences between preventive and diagnostic care will definitely help you understand how you avail your benefits.

Diagnostic services can include:

• Casting and splinting for broken bones and other injuries
• Controlling chronic pain
• Addressing new symptoms suggestive of an injury or sickness.
• Managing chronic conditions like obesity, diabetes, high cholesterol, and high blood pressure.

Why Does It Matter If Your Coverage is Preventive vs Diagnostic?

Your group health insurance coverage may be different depending on preventive vs diagnostic care. Most of the preventive services are covered at 100% (at no out-of-pocket cost). 

However, you have to ask your doctor the reason behind asking for a test. The same test or service can be preventive or diagnostic, based on why it is done and the cost for the service may change depending on how it is defined. 

Here are a few instances of how the same tests can be preventive and diagnostic:

Test/ServicePreventiveDiagnosticBlood Pressure TestA person with no history of abnormal blood pressure gets a routine blood pressure check to screen for high blood pressure.A person with risk factors for high blood pressure, like being obese and smoking, visits the doctor because he/she has early morning headaches.MammogramA woman of age 55 years getting a routine mammogram to screen for breast cancer.A woman who noticed a lump in her breast gets a mammogram to further evaluate the lump.

Is Preventive and Diagnostic Care Free?

In most cases, group health insurance policies offer eligible preventive care services free of cost. Nevertheless, depending on your policy, you may have to pay something for diagnostic care. 

If both preventive and diagnostic care are provided by a clinician during the same visit (for instance, a routine checkup), you may need to pay a portion for the diagnostic service. 

As coverage varies greatly among various insurance plans, we recommend that you thoroughly understand what your specific plan counts as preventive and diagnostic care and what you may be responsible for paying out-of-pocket for these services. 

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FAQs‍

Q: What is the main difference between preventive and diagnostic care?

A: Preventive care focuses on measures taken to prevent diseases, while diagnostic care involves identifying and managing existing health conditions.

Q: What does preventive care involve?

A: Preventive care includes routine check-ups, screenings, and immunizations intended to prevent health issues or detect them at an early stage.

Q: What does diagnostic care entail?

A: Diagnostic care involves managing or treating existing illnesses or symptoms, which may include diagnostic tests, medication, and other treatments.

Q: Can a medical service be both preventive and diagnostic?

A: Yes, certain services can be both. For instance, a mammogram can be preventive (when used for routine screening) or diagnostic (when investigating a detected lump).

Q: Is one type of care more important than the other?

A: Both are essential for maintaining overall health. Preventive care helps stop health issues before they start, and diagnostic care helps manage and treat conditions that have already developed.

Q. How can patients ensure that their healthcare provider correctly codes their visit as preventive when it should be, to avoid unnecessary charges?

A. Patients should discuss with their healthcare provider before the appointment about its nature being preventive. Therefore, confirming the visit's coding as preventive with both the provider and insurer is essential.

Q. What steps should individuals take if they are incorrectly charged for preventive services that should have been covered at 100% by their insurance?

A. If charged for preventive services, individuals should first review their insurance policy details. Then, contact their insurer for clarification. If necessary, they can also request a billing review from the healthcare provider. Therefore, persistence is key in resolving such issues.

Q. Are there any exceptions or special circumstances under which diagnostic care might be covered at the same rate as preventive care by insurance plans?

A. In some cases, diagnostic care may be fully covered if it's part of a follow-up to a preventive service. Therefore, it's crucial to check with the insurance provider about specific circumstances that might allow for such coverage.