Preventive care is free to you
Preventive care is paid in full by either medical program option — no deductible, no copay. Before you go, be sure to check which preventive care services are covered by the plan.
Benefit tip: Keep in mind, if you go in for preventive care, but then talk to your doctor about other issues, the visit may change from 100% covered preventive care to a regular office visit with a copay. Doctors must provide codes to the insurance carrier for all of the services they provide. If there’s a code for something other than preventive care, you will be charged.
For example: John goes to his primary care provider for an annual preventive physical. This service would be covered at 100%. However, during the visit, John brings up a pain he has started having in his knee. His doctor sends him for an X-ray. John now has to pay $20 for the office visit plus 20% of the charges for the X-ray.
Advantages of choosing a primary care provider (PCP)
A primary care provider (PCP) sees patients for common things like colds and flu, headaches, or back pain. They also manage chronic conditions like high blood pressure, diabetes, anxiety, or depression. They can refer you to a specialist if you have a health issue that falls outside their scope. Having a PCP is a great way to keep your care coordinated. They can also help you track your health from year to year and prevent expensive ER visits.
Save two ways with in-network providers
If you are enrolled through Kaiser Permanente, you must use Kaiser Permanente providers except in an emergency.
If you are enrolled through Regence PPO, you have a choice each time you get care — choose an in-network provider or an out-of-network provider. Using in-network providers helps you manage your costs in two ways:
- When you receive services from in-network providers, your plan will pay a larger portion of the cost for most services than it would for out-of-network services.
- In-network providers will not charge more than the “allowable charge.” The allowable charge is the discounted rate Regence PPO has negotiated with their “in-network” providers. After you meet your deductible, your plan will pay up to the allowable charge less any coinsurance or copay you owe.