Health Insurance Covers Preventive Care- But What Is Preventive Care?

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PREVENTIVE CARE

In the year 2001, the Centers for Disease Control and Prevention (CDC) established an office in Nigeria. The CDC collaborates with the Federal Ministry of Health (FMOH) and state ministries of health to fight HIV, malaria, tuberculosis, and vaccine-preventable diseases. Even though many do not take notice of their activities, their activities was evidence during Covid-19 pandemic as they supports laboratory, surveillance, and workforce capacity in response to disease outbreaks.   

By now, many consumers know that health insurance plans are required by law to cover 100 percent of the costs for preventive care. However, a question we often hear is, “What is preventive care?”

Preventive healthcare, or prophylaxis is the care you receive to prevent diseases or illnesses. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention. Preventive healthcare, or prophylaxis also includes counseling to prevent healthcare problems. Providing these services at no cost is based on the idea that getting preventive care, such as screenings and immunizations, to help you, your family and loved ones to stay healthy. Preventive care may also assist reduce the cost of your health care down the road if you catch a problem early, or if an immunization keeps you from getting a serious illness.

Here are a few pointers about what’s covered, plus tips to help you know what to expect.

A few examples of preventive care services:

  • The standard immunizations and wellness visits.
  • Screenings for blood pressure, cholesterol, depression, 
  • cancer, 
  • obesity, and Type 2 diabetes
  • Pediatric screenings for vision, autism, hearing and developmental disorders, depression, and obesity

There are certain recommended preventive services and immunizations based on your age and gender. 

Preventive Care Including Early Detection Of Illness

The purpose of this essential public health operation is to prevent disease through actions at primary, secondary and tertiary levels. Most of these actions fall within the role of health professionals and health care providers in primary care, hospitals and community services environment.

There are three levels of preventive care and each of the three approaches has an important role to play in disease prevention. However, upstream approaches, e.g. primary prevention, generally tend to be cheaper and more efficient, and they entail lower morbidity and mortality rates. Health promotion is inextricably intertwined with disease prevention.

  1. improving the overall health of the population (primary prevention)
  2. improving (secondary prevention)
  3. improving treatment and recovery (tertiary prevention).

A recent self-assessment of public health services in Nigeria found that:

  • Primary prevention: routine immunization programmes are established in some form nation wide, and in most cases are well developed and effective. However, arrangements for delivery of vaccine programmes are under-developed in Nigeria, especially for minority populations. 
  • Secondary prevention: routine screening for major forms of cancer now exists in Nigeria, but not in all of the state. Screening programmes are not always evidence-based and systemic health checks for noncommunicable diseases are not routine in Nigeria.
  • Tertiary prevention: lack of availability and affordability of treatment for early stage cancers is a limiting factor in Nigeria. Staff need training in evidence-based treatment and management approaches for noncommunicable diseases, and modern equipment.

As a result, a recommendation was made to ensure a balance in the three disease prevention approaches: primary (vaccination and health promotion), secondary (screening and early detection of disease) and tertiary (integrated patient-centered disease management).

Vaccine – Preventable Diseases and Immunization

Nigeria need to provides policy and technical assistance to maximize equitable access of all people to vaccines of assured quality as part of the Global Immunization Vision and Strategy.

Primary Healthcare

Nigeria may need to conduct studies on organization and provision of primary care services. It provides data to facilitate comparisons on performance in primary care services.

Mental Heath and Mental Disorders

Many organizations in Nigeria are promoting mental health services,  our government need to support such organizations to  run a project to empower users of mental health services and their families.

HIV/AIDS

Nigeria through the NGOs, CDC and other agencies is supporting the health system approach in tackling the HIV epidemic and we hope they do better.

Tuberculosis

Nigerian government has  implemented the Stop TB Strategy, and together with its partners is developing a consolidated action plan to prevent and combat TB.

Cardiovascular Diseases, Cancers, Chronic Respiratory Diseases and Diabetes

WHO supports countries with surveillance of diseases, risk factors and enhancing early detection of diseases.

 

Is There Ever a Chance You Might Have to Pay?

Many preventive healthcare services are 100 percent covered by insurance. For example, if you have an insurance plan, you won’t have to pay anything for these services if you see a doctor or health care professional within their network hospital.

Although, there’s a chance that you may be asked to pay for additional services.

  • It’s important to make sure that you and your doctor are on the same page, talk freely with your doctor and always ask what services your doctor is providing. What you pay will also depend on how the hospital bills your healthcare insurer.
  • If a preventive healthcare screening uncovers something that could be serious, your doctor may order additional tests, schedule a follow up visit, or refer you to a specialist. The additional tests and follow-up may not be 100 percent covered.
  • If a preventive healthcare screening uncovers something that your doctor says needs to be addressed immediately, then that visit may switch from being a prevention services to treatment. Also, if you see a doctor to diagnose, monitor, or treat an illness or injury, the visit is not considered preventive healthcare services. 
  • There may be limits on the number of preventive services you can receive with no out-of-pocket cost. For example, in some plans, a wellness exam may be 100 percent covered once every year. However, if you get a checkup more often on request, out of pocket fees may apply.

In any case, it’s always a good idea to check with your healthcare insurance company (HMO) ahead of time on the services that will be covered.

What If You Are Charged for a Preventive Care Service?

If you’re charged for a preventive healthcare service – a service you believe should have been 100 percent covered, here’s what you should do. Keep your paperwork. You can save a lot of time later if you keep your  bills and paperwork handy.

  • Check with the HMO department’s office and ask what services were billed to the Healthcare Insurer (HMO).
  • Does it match what you remember from your visit? If it turns out there was a mistake, the HMO department’s office can send a corrected claim to the health insurance provider.
  • Also check with your healthcare insurer and ask what services the HMO department’s office billed. Does it match what you remember from your visit?
  • Ask the HMO department for a reimbursement, if they agrees that a mistake was made with your bill.

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