Technical Question About Health Plans

[scottfanli]

Hey everyone I have a technical question about health insurance plans in general. Let's say on a united copay select plan what is the difference between preventative care, and xray/lab. There's a clear difference in price (copay vs deductible + coinsurance) but say John Smith believes he has cancer. Is everything covered under the simple copay for preventative care services or does he have to get an xray/lab?

thanks

 

[GreenSky]

If the testing is because of a diagnosis or to rule out a diagnosis (cancer), it's not preventive. Preventative is a routine physical. If that physical determines that more tests are necessary, then the subsequent tests are not preventive.


Rick

 

[scottfanli]

thanks
are there limits on how many physicals you can have within a certain time frame?
also, are periodic exams the same thing as physicals?
and about immunizations, what category would that fall under, would it be covered under preventative?

 

[retread]

thanks
are there limits on how many physicals you can have within a certain time frame?
also, are periodic exams the same thing as physicals?
and about immunizations, what category would that fall under, would it be covered under preventative?

In regard to frequency of visits, airline pilots are required to be seen by their flight surgeon twice a year by regs. Since I retired after over 30 years as an airline pilot, I thought this was a good program to follow. So did my physician, who is an internist/cardiologist. After 5 years in retirement, he has reduced the physicals to annually. The point is, that more frequent physicals can place the doctor in a quick place to respond to changes in your health, but will be more costly. This is a luxury if not required in your occupation. As my bank account gets thinner and I get fatter, I choose to go see him less often... I hate getting on the scales almost as much as shelling out for the co-pay...

 

[Crabcake Johnny]

While most health plans don't limit the number of preventative visits they often limit the annual maximum - swings between $200 to $1,000 in many cases.

 

[scottfanli]

appreciate all the help
here come some more questions lol
what is well baby care?
or wellness care?
for the preventative care stuff, do you see your primary doctor or specialist?
for specialist office visits, when would one see a specialist as opposed to a primary doctor?, if someone could give me an example that would be great
about the flu shots, so if i was on a golden rule copay select, it would still be copay plus deductible plus coinsurance or just copay or in other words when reading a brochure, do they fall under preventative care or is it its own separate category?
On the Aetna brochure where they list the pricing, what's considered hospital admissions, Urgent Care Facilities, durable medical equipment and Skilled Nursing? examples would be nice lol
for some Aetna plans for prescription meds it says 60 day supply, does that mean it only covers a maximum supply of 60 days?

Thanks

 

[retread]

appreciate all the help
here come some more questions lol
what is well baby care?
or wellness care?
for the preventative care stuff, do you see your primary doctor or specialist?
for specialist office visits, when would one see a specialist as opposed to a primary doctor?, if someone could give me an example that would be great
about the flu shots, so if i was on a golden rule copay select, it would still be copay plus deductible plus coinsurance or just copay or in other words when reading a brochure, do they fall under preventative care or is it its own separate category?
On the Aetna brochure where they list the pricing, what's considered hospital admissions, Urgent Care Facilities, durable medical equipment and Skilled Nursing? examples would be nice lol
for some Aetna plans for prescription meds it says 60 day supply, does that mean it only covers a maximum supply of 60 days?

Thanks

Whew! Methinks you are going to school on us. We are working stiffs, and don't have that much time to pour into your requests. Why not google as much as you can and glean the info yourself, or buy some good books. Also available are associations that offer online courses....

 

[motoxxx]

Just goes to show you tht there are many different types of plans and variables. It pays to do your research doesn't it?