Most of Quartz-branded health plans provide Preventive Health Exams (PHEs) with no copay, even if the member has not met their deductible for in-network care.

Many members do not understand the difference between a PHE and a diagnostic service, especially if they occur in the same visit. They are unpleasantly surprised when they receive a bill for what they thought was a free exam.

When a member calls to set up a PHE, be sure to explain that they may be charged for a service if it is a diagnostic service provided during the PHE. You can refer them to this flyer that shows what services are provided without copay.

Alternatively, the member can call Quartz and ask the following questions about the upcoming exam –

  • What is covered when my office visit is primarily a preventive health care visit?
  • What does my policy cover if I’m seeing my health care provider about a new or existing health care issue?
  • If I go to the doctor for a preventive health exam and the focus changes to a specific health issue, will my policy cover both portions of the visit?
  • What are my out-of-pocket costs for copays, coinsurance or deductibles for each kind of visit?

If you are providing a PHE, please notify the member if a potential service is diagnostic and not included in the PHE. The member can then choose to make another appointment for the diagnostic service or accept the possible copay.

shutterstock_133030739