To understand whether a service is preventive or diagnostic, it’s important to discuss your ongoing care with your physician. You can also call the Member Service number on the back of your member ID card if you have questions about which services are fully covered. Diagnostic services may require a copay, coinsurance, or deductible — as indicated by your health plan.
What is a preventive screening?
Preventive screenings are routine tests that can help you stay well by finding or detecting problems early, when they’re easier to treat. They’re administered when you don’t have symptoms or a current diagnosis of disease. For example, Pap smear screenings can be done annually or every three years to detect cervical cancer.
Preventive care also includes services like:
Annual wellness visits.
Immunizations like flu shots.
Certain lab tests like cholesterol checks.
What is a diagnostic service?
Diagnostic services and tests are prescribed by a doctor when you’ve been diagnosed with a disease or have symptoms that need to be evaluated. These services may also include test results that may have been abnormal or not in a normal range. For example, if you’re experiencing cervical pain or bleeding, your doctor may prescribe a more comprehensive diagnostic Pap smear test. This is different than a preventive Pap smear screening.
Diagnostic care may also be given during your preventive care visit. For example, during an annual wellness visit, if your doctor is treating a chronic condition, they may want to investigate further by ordering additional tests. These may require a copay, coinsurance, or deductible. Other types of diagnostic services can include:
Laboratory blood tests for diagnosed high cholesterol and diabetes.
Who dictates the preventive screening schedule?
The preventive schedules Highmark uses are based on the federal mandates under the Patient Protection and Affordable Care Act (PPACA) from the United States Preventive Services Task Force (USPSTF), and the immunization schedule from the American Academy of Pediatrics’ Bright Futures initiative and the Centers for Disease Control and Prevention (CDC). State mandates are also followed.
How much do preventive and diagnostic screenings cost?
Both types of screenings may be covered at no cost to our members. In most cases, there is no cost for preventive screenings. However, cost-sharing practices like copays, deductibles, and coinsurance may apply to diagnostic care received at an appointment, even if it’s a preventive office visit. It’s best to check with your doctor, contact us through the member portal, or call the Member Service number on the back of your member ID card.
What if I’m not sure if the screening is preventive or diagnostic? Where can I find my preventive schedule?
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.
This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. This website does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Enter your ZIP code so we can show you personalized information.