Wellness Vs. Diagnostic: What's The Difference?

October 13th, 2020


Before you visit your provider, it is important to understand the types of services you receive and how they will apply to your healthsharing membership. As always, it is important to remind your provider or facility of your status as a healthsharing member and request a self-pay discount prior to receiving care. This will ensure you receive fair pricing, and helps to preserve your community’s SharePower.

When you visit the doctor, Liberty HealthShare requires that you submit every medical expense with the correct industry medical billing codes. This gives our medical bill processing team the documentation needed to determine that the expense aligns with our agreed upon Sharing Guidelines. Once eligibility is confirmed, the bill can be processed and then applied to your AUA or submitted for sharing. You may be wondering how these codes work and why a visit may be considered and coded as a wellness or diagnostic visit.

Both of these forms of care are important parts of keeping you healthy but they are different and impact your healthsharing membership differently as well.

When you schedule a wellness visit or screening, the routine exam and lab work are conducted for preventative care. These services help to ensure that you are healthy, and when nothing arises in your exam that requires further treatment, your provider will code and invoice these services under wellness. So what does this mean when you submit your wellness expenses to Liberty HealthShare? Your eligible medical expenses will be shared by the community according to your sharing program and our Sharing Guidelines relative to wellness.

Though, this may leave you wondering, what diagnostic services are and how they are different from wellness. There are a few circumstances in which your provider may order diagnostic treatment:

  • if you mention a concern that requires evaluation,
  • your doctor sees a potential health concern during a routine visit and performs a diagnostic exam;
  • or your doctor provides you diagnostic services for an existing condition.

In these situations, your doctor will code these services as diagnostic, meaning the purpose of the services performed were to diagnose or determine what is ailing you.

It’s also important to know that the some of the same tests can be considered preventive or diagnostic depending on the circumstance. A service performed during a wellness visit may be categorized both preventive and diagnostic:

For instance:

  • Preventive: A routine mammogram for women.
  • Diagnostic: The doctor identifies an abnormality during the routine mammogram and recommends a diagnostic mammogram to make further determination of the issue.

Before receiving diagnostic screenings, it important that you call our prenotification department so they can help you to determine eligibility for the service. This includes MRI and PET scans, diagnostic colonoscopies, endoscopies, diagnostic mammograms, upon the diagnosis of cancer and more. It is always best to reference our Sharing Guidelines to determine if you should notify our prenotification department prior to receiving the service.

If you have any questions about whether or not your next doctor’s visit will be considered a wellness or diagnostic visit, you can give us a call at 855-585-4237 and we will be happy to help guide you. 

 

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