Preventative vs New Problem FAQs

What is the difference between preventative care and acute or ongoing care?

Ongoing or acute care involves the diagnosis, treatment, and monitoring of specific diseases and conditions.

Examples of ongoing or acute care include:

• Diagnosing or addressing a new condition that is identified during your physical exam, such as a UTI, yeast infection or breast mass or abnormality.
• Monitoring or treating a condition you already have, such as diabetes or pre-diabetes, which may involve refilling medications.  While this can be done at a preventative health visit for your convenience, typical health plans mandate that there be a specific additional charge for these services.
• Some vaccines are routine and others are only needed for specific situations.  Vaccines that are not considered routine and are only needed in certain situations.  Routine vaccines are usually covered by your health plan.
• Every health plan has certain laboratory tests that it covers 100% and others that are considered non-routine and may be charged to you or as part of your deductible.
  Prescription management for medication other than refill of current birth control

How will I be billed if the above scenario occurs?

In cases like these, the acute or chronic medical care part of the visit will generate an additional copay or count toward your out of pocket expenses.

Unfortunately, we cannot change this practice.  Modern Women’s Health contracts with over 50 insurance companies.  We apologize for any inconvenience to you and appreciate your understanding that we must follow medical billing guidelines in order to submit claims on your behalf.  Any questions related to your benefits should be directed to your insurance company or your employer’s Human Resources dept.