Preventive vs. Diagnostic Care: What’s the difference?

The services you receive from your health care provider are coded as preventive or diagnostic. This coding determines whether your health plan covers the service at cost or is subject to your deductible, co-insurance or co-pay. Know the difference to save money and maximize your health plan's benefits.

What is preventive care?

Preventive care includes screenings and services that can help uncover health issues before symptoms appear. Early detection is crucial to potentially preventing them from worsening and achieving the best outcome.

Preventive care can include:

• Routine checkups
• Blood work
• Depression and anxiety screenings
• Pelvic and breast exam for women
• Mammogram for women
• Cancer screenings — including colon, lung, cervical and breast cancer
• Diabetes screening
• High blood pressure screening
• Osteoporosis screening
• Some immunizations

If you have a GuideStone^® health plan, download the Preventive Schedule to identify services available at no additional cost.^1,2

What is diagnostic care?

Diagnostic care includes services you receive when you have symptoms, risk factors, an illness or an injury. Your health care provider uses it to identify the issue, monitor a condition or recommend treatment.

Diagnostic care can include:

• Office visits
• Lab tests
• Ultrasounds
• Radiology
• Management of chronic conditions

Can a preventive care visit lead to diagnostic bills?

If a health care provider uncovers an issue during a preventive exam and decides to run additional tests or prescribe treatment, it could result in diagnostic bills. To help keep a preventive exam covered at no additional cost, ask your provider to schedule a subsequent appointment or discuss off the record any new conditions or illnesses.

3 Ways It Pays to Understand Your Care

1. Save money. When coded correctly, preventive services can be provided at no cost to you.² Let your in-network health care provider know you’re seeking preventive services when scheduling your appointment for eligible routine care. Then, monitor your explanation of benefits (EOB) statements to verify that the services are submitted with accurate information.
2. Promote your well-being. Preventive care can help identify issues before they progress to more severe conditions later. This can potentially improve outcomes and help avoid more invasive and costly treatments.
3. Maximize your benefits. If a medical service, such as a vitamin D test, is denied when coded as preventive, you may ask your health care provider to resubmit the claim as diagnostic. If approved, the service could then be applied toward your deductible.

Coverage That Supports Your Calling

¹Not applicable for Cigna Healthcare^® International plans and Medicare-coordinating plans.

²Preventive care is covered at no additional cost when using in-network providers and facilities for eligible routine preventive care.