When you receive preventive care, you won't have a copay. During that visit, if you also receive care that's not considered preventive care, then a copay will be charged. For example: If you go to your doctor for a seasonal flu shot and an annual wellness visit, you wouldn't have a copay because these are preventive care services. It's helpful to know what types of care are considered preventive.
Preventive care includes:
An annual wellness visit that is a comprehensive, preventive medicine evaluation that results in a prevention plan based on your needs
Services to help you avoid illness or injury, including flu shots or pneumonia vaccines
Tests and screenings to detect undiagnosed diseases or problems, including routine cancer screenings, such as mammograms
Preventive care does not include:
Diagnosis or monitoring of a problem or symptom you already have
Treatment of pain or other symptoms of an illness or disease
Treatment of problems found during a preventive care appointment
Sign in to see your specific plan benefits. Or find your Medicare plan and refer to your plan documents for Evidence of Coverage.
In your member portal, you'll find a summary in "Claims Overview" under "Claims" in the navigation. To view details of a specific claim, click on the claim number. If your claim information isn't immediately available, keep in mind it takes time for a claim to arrive from your provider, be processed, and show up in your member website.
What does the status of my pharmacy claim in my member portal mean?
As you're reviewing your "Claims Overview," keep in mind current status will be shown. Claim history is not shown. You can find more detailed claim information at Express Scripts®.
Information to help you
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