Periodically, Harvard Pilgrim receives questions from physicians and members about whether it’s necessary to wait a full year between preventive care visits, in order for the visit to be covered. As a reminder, Harvard Pilgrim does not limit preventive care visits (routine medical exams). Therefore, if a member has a well visit on July 1, 2013, she does not need to wait until July 2, 2014 to obtain her next routine exam.
This policy is in keeping with federal health care reform. While the preventive care visit policy applies to most fully insured employer accounts, there are some exceptions. Fully-insured and self-insured employers that have opted out of federal health care reform may impose limits.
Please also keep in mind that under federal health care reform’s Affordable Care Act copayments do not apply to preventive care visits. Please use ICD-9 code V70.0 (routine medical exam) to ensure that billing is accurate. For more information, see the Federal Health Care Reform page on Harvard Pilgrim’s provider website.