Although HSA’s generally tend to have high deductibles, one great benefit is that preventative care is covered 100% for almost all HDHP plans. A recent industry survey found that over 80% of HSA plans provided first-dollar coverage for preventive care. This was true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. So if you have a HSA, the odds are pretty good that preventative care is covered 100%.
As the name suggests, preventative care is anything that will prevent you from getting sick or having to see the doctor. The reason why preventative services are often covered is because it’s in the insurance companies’ best interest for you to stay healthy and never see a doctor. That way, they can collect premiums and never have to pay for anything major. That’s why physicals and flu shots are covered(it’s not too late for your flu shot btw!) by most HSA’s.
You’re basically leaving money on the table if you don’t get a physical every year. I get a physical at the beginning of every year and if it wasn’t free I’d probably only get one every 2-3 years. There are lots of good reasons to get a physical and you’ll definitely need one if you ever plan on getting life insurance so don’t be lazy, make your appointment right now.
Is Lab Work Covered?
Last year around this time, I went in for my annual physical and the doctor ordered a bunch of routine blood work. In all, he ordered 8 different blood work tests to be performed. As soon as I saw that list though, I was worried that my HDHP provider(Aetna) would not cover them all. I ended up not getting the tests done since I didn’t want to pay for it later. Fast forward one year and I’ve done my homework this time around. I have a physical scheduled in two weeks and I’ve figured out exactly what is and isn’t covered.
Crash Course in Medical Diagnostic Coding
Each lab test will have a separate name and diagnostic code. As long as the code and test are preventative in nature, they’ll be covered. The main thing to consider is the diagnostic code. You should see the code V70.0 somewhere next to the test name or description. V70.0 is the ICD-9-CM diagnostic code for a routine medical exam(preventative). The code is also the reason why the test is being done.
The second thing to look at is the test itself. If the test falls under preventative or routine, you should see a short description saying so underneath the test name or in the test description. If you go in for a physical and the doctor decides he wants to run a bone marrow test for the heck of it and codes it V70.0 it still won’t be covered since the test is not a routine medical(preventative) test.
As long as you see the correct diagnostic code and a description of the test as normal, routine or preventative you know that test will be covered.
What to do
If you’re still worried that your tests may not be covered you can always request a copy of the tests ordered by your doctor. While you’re waiting at the doctor’s office you can call your insurance company and give them the name of each test and it’s associated diagnostic code. They should be able to tell you if it’s covered or not. I didn’t have much luck getting this information from my doctor’s office but my insurance company was surprisingly knowledgeable and helpful.
Knowing these codes will help you decipher your medical bill and you might even be able to catch a doctor’s mistake. Incorrect coding is one of the main sources of medical insurance fraud so it’s important to be on the lookout for this as a consumer. You never want to pay more than you have to.
Readers, did you know that most HDHP/HSA’s covered preventative services like physicals and blood work? Did you know what a medical diagnostic code was before reading this article?
-Harry @ PF Pro
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Chris @ Stumble Forward says
That’s some good tips their Harry. My sons going in next week to have his ears checked by a specialist to see if he needs tubes for his ears or not. I did this same appointment with my younger son and they never covered it as preventive. However, I will be asking them this time around.
I’m also wondering if checkups for my kids is also considered preventative as well. I am defiantly going to talk to my doctor about this. Thanks a bunch.
Harry Campbell says
Thanks Chris. I don’t think that will be covered as preventative but it’s worth a shot. If you go in there like you know what you’re talking about with respect to the medical coding, I think you’ll be more likely to get what you want.
Is a check-up the same as a physical? I think it is and if so as long as your insurance company covers preventative 100% then you should be fully covered. Just make sure they code everything with the correct code. Google whatever code they give you and you can double check yourself.
Lance @ Money Life and More says
I do know that preventative is covered but have no clue what falls into it. Now I at least know a bit of what to look into! Thanks for the info… I’m sure it’ll come in handy.
Harry Campbell says
No problem Lance. If preventative care is covered, you should be covered for physicals, flu shots and lab work. Just make sure they use the right code for everything and you can double check with your insurance company too.
good post, I feel like this topic could go on forever! Just heard a story today about breast pumps now being covered by insurance turn a small boutique into a huge, thriving business.
Harry Campbell says
Haha yea I heard that planet money podcast too. They brought up some really good points though why they shouldn’t be covered. I agree with them on that since you’re basically paying a middle man(insurance company) if everyone gets them. That’s why if I’m gonna pay for it I might as well take advantage of it.