An Ounce of Prevention…

Posted on June 11, 2013

Your Health New England (HNE) insurance plan covers one preventive exam annually with no cost sharing (deductible, copay).  This exam can identify health problems in the early stages.  That way, they may be easier to treat.  This exam consists of:

• Review of your medical, social and family history
• Physical exam
• Review of your medications and immunizations
• Counseling for risk-factor-reduction interventions
• Age- and gender-related screening or testing

This exam is focused on prevention.  Your provider can bill HNE for any additional care you receive.  When additional care is required, you will be responsible for any deductible or copayment.  The following are examples of care that is not part of a preventive exam:

• Examination for an illness or injury
• Follow up on an existing disease or condition
• Assessment of a new problem discovered during your exam
• Examination or treatment resulting from abnormal testing results

To better understand how you will be billed for your exam, you can do the following:

• When you schedule your exam, use the words “preventive exam” or “annual physical.”
• At the time of your exam, tell your provider that you are there for a preventive exam.  Ask what testing and exams are preventive and what are not.  Discuss any additional services with your provider.  Only your provider can decide what services you need to keep you in good health.
• You also can contact HNE Member Services at 413.787.4004 or 800.310.2835 Monday-Friday, 8:00 a.m.-5:00 p.m.  We can answer any questions about what is covered in a preventive exam.

If you receive a bill for a deductible or copayment that you do not think should apply, discuss the issue with your provider first.  That way, you can determine what portion of the visit was not preventive.  If you are unable to resolve the issue with your provider, contact HNE Member Services at the numbers listed above.

Note: Some self-funded groups do not cover preventive services at 100% and still have a deductible and/or copay for these services. Please check with your employer if you are not sure what preventive benefits your plan offers and at what cost, if any.

Categories: Newsletter, Summer 2013