The Difference Between Wellness Visits, Preventive Care Services and Diagnostic Care

Monday, March 14, 2022

A Message from Jessica Johnson, UnitedHealthcare Nurse Liaison 

Telling the difference between preventive care services, a wellness visit and a diagnostic visit can be confusing. Medicare and other insurers define the annual doctor visit as a “wellness visit.” Sometimes it’s called a “well visit” instead, reminding us we should be scheduling these visits when we are “well,” as opposed to when we are “sick.” You will often receive your preventative care services (routine wellness exams, screenings and immunizations) during your annual well visit and that is okay. As long as you do not receive any diagnostic care during this visit, your visit will be covered 100% by your insurance if you choose an in-network provider.

Diagnostic care is given when you have an abnormal screening or have symptoms that require further diagnosis. For example, a radiologist may ask for a follow-up mammogram for a patient. This follow-up checks for something that may have been detected during the preventive or routine mammogram. The follow-up mammogram is diagnostic and not covered as preventative care.

Examples of preventive health services:

  • Complete physical exam
  • Immunization review and update
  • Age-appropriate heart disease screenings (blood pressure, blood glucose and cholesterol tests)
  • Cancer risk screenings (pelvic exam, Pap smear, prostate and colorectal screenings)
  • Sexually transmitted disease testing
  • Evaluation for signs of depression
  • Alcohol, depression, obesity and tobacco counseling

Examples of non-preventive care include:

  • Diagnostic tests and screenings for a particular issue
  • Additional primary care visits: Most health plans will cover you for one annual checkup with your doctor. Other visits during the same calendar year will likely not be covered as preventive.
  • Specialist visits: Visits to a specialist (gastroenterologist, orthopedist, neurologist, podiatrist, etc.) for a particular problem are not covered as preventive care.
  • Alternative therapies: Services such as chiropractic, massage, acupuncture and other alternative health services are not considered preventive care.

Is it time to schedule your yearly checkup? Checking in on your health and getting recommended preventive care may help paint a more accurate picture of your overall health. To learn how to choose a doctor, click here.

Click here for a UnitedHealthcare preventative care checklist based on your age.

If you have any questions, contact me at jessica_r_johnson@uhc.com or 407-866-8134.

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