Wellness
Common Questions
The doctor visit portion of my annual exam wasn’t covered under the wellness benefit.
Claims are paid based on the diagnosis code your doctor provides. Many doctors will code visit as a consultation visit if you discuss existing conditions or symptoms during your wellness exam. While the visit and any specific diagnostic tests will be paid under the general benefits of your plan, all routine wellness lab tests, etc. will still be paid under the Wellness benefits. If you don’t believe that was the case, call Blue Cross customer service to make sure the charges were coded correctly. If not, you may need to contact your provider to resubmit the claim.
My doctor is a network provider but when I had my annual exam, he sent me to another facility for a test . 100% of the charges at the doctor’s office were covered but I had to pay some of the charges for the test.
The other facility may have been a non-network facility. In that case, BCBS IL will pay 100% of what the in-network charges would have been. You would be responsible for the remaining charges. Check with your doctor beforehand when you are referred to another provider or facility. Another reason could be the diagnostic code provided by your doctor. You should also check with Blue Cross customer service to make sure all charges were coded correctly.
When my claim was processed, my annual mammogram wasn’t covered.
Call Blue Cross customer service. It could be that your provider used a diagnostic code rather than the preventive code. Blue Cross should be able to adjust your claim with just a phone call.
Are there age limits or frequency limitations on my wellness benefits?
No, eligible charges for tests and visits are covered regardless of your age or frequency as long as they meet the wellness requirements and are not due to a diagnosed condition.