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    • Preventive: Why Am I Being Charged?
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PROUDLY SERVING UTAH
PUBLIC EMPLOYEES

Trust • Commitment • Value • Innovation • Excellence

Members

Utah depends on its public employees, and they depend on PEHP.

  • Using Your Benefits
    • Using Your Benefits
    • Preauthorization
    • Member ID Card
    • Appeals
    • FLEX$
    • COB
    • Save With an HSA
    • Long-Term Disability
    • PEHPplus
    • Health Insurance Basics
  • Your Network and Your Money
    • Your Network
    • In-Network Rate
    • Balance Billing
    • Out-of-Network Benefits
  • Prescription Drug Benefit
    • Prescription Drug Benefit
    • Express Scripts Home Delivery
    • Preauthorization
    • Specialty Medications
    • Covered Drug List
    • Common Pharmacy Questions
    • Locate a Pharmacy
    • Coordination of Benefits (COB)
    • Medicare Part D
    • Forms
    • Prescription Assistance Programs
    • Pharmacy Tourism Program
  • PEHP Value Providers
    • Overview
    • PEHP Value Clinics
    • Prescription Assistance Programs
    • Laboratory
    • Radiology
    • Ambulatory Surgical Center
    • Colonoscopy
    • Intermountain Connect Care
  • Preventive Services
    • Preventive Overview
    • Preventive: Why Am I Being Charged?
  • PEHP Wellness
    • PEHP Wellness
    • PEHP Healthy Utah
    • PEHP WeeCare
    • PEHP Health Coaching
    • PEHP Integrated Care
    • PEHP Quit Line
    • Resources for Diabetes
    • #LiveShareInspire Videos
    • myWellness Tracker
    • Wellness Resources
  • Publications
    • Publications
  • Appeals
    • Claims Appeal Process
    • Appeal Filing Form
    • Authorized Representative Form
    • External Review Request Form (Records Release Consent Form)

Preventive Services: Why Am I Being Charged?

PEHP generally pays in-network preventive visits at 100%. However, you’ll be billed if you get additional treatment or services at your preventive visit. An “additional service” could be something as minor as a discussion with your doctor about a past or current condition. 

Example: You schedule a preventive service. While at your appointment, your doctor asks if you have any symptoms or complaints. You tell the doctor about recent knee pain, which she exams and diagnoses. The doctor's office bills PEHP with a charge for the preventive exam and a separate charge for the exam of the knee. PEHP will pay 100% of the charge for the preventive exam (if you used an in-network provider), but you may be responsible for a portion of the bill for the knee exam.

Certain screenings, such as a blood test, colonoscopy, or mammogram, may identify health conditions that require further testing or treatment. If a condition is identified through a preventive screening, any subsequent testing, diagnosis, analysis, or treatment at the same appointment may be billed separately from the preventive visit.

Example: You schedule a cholesterol screening (an eligible preventive service for adults over a certain age). Your doctor orders blood tests, which reveal your cholestrol is high. During the visit, your doctor discusses how to manage the condition and prescribes medication. The doctor's office bills PEHP with a charge for the cholesterol screening and a separate charge for the treatment of high cholestorol. PEHP will pay 100% of the charge for the eligible preventive exam (if you used an in-network provider), but you may be responsible for a portion of the bill for the treatment of high cholestorol.

Ask your doctor how your visit will be billed; PEHP pays based on how it’s billed.

» Learn More About Preventive Visits

PEHP Lighten Up

Join our FREE online weight management class developed by PEHP Registered Dietitians. PEHP Lighten Up is an eight-week, web-based course that is held multiple times throughout the year. Learn more about the class and reserve your spot here.

On-Demand Doctors

Intermountain Connect Care offers convenience and savings to all PEHP members with live, on-demand doctor visits online or by phone.

PEHPplus

PEHPplus provides savings of up to 60% on a wide assortment of healthy lifestyle products and services.

PEHP Healthy Utah

Access PEHP Healthy Utah. Make sure you and your spouse create your individual PEHP for Members accounts at www.pehp.org to schedule your testing session, see results, and to apply for rebates. Learn more

 

PEHP Healthy Utah

Access PEHP Healthy Utah. Make sure you and your spouse create your individual PEHP for Members accounts at www.pehp.org to schedule your testing session, see results, and to apply for rebates. Learn more

Find a Provider

Search for doctors, clinics, and hospitals in your network at the PEHP Provider Search. Find a Provider

On-Demand Doctors

Intermountain Connect Care offers convenience and savings to all PEHP members with live, on-demand doctor visits online or by phone.

PEHP Healthy Utah

Access PEHP Healthy Utah. Make sure you and your spouse create your individual PEHP for Members accounts at www.pehp.org to schedule your testing session, see results, and to apply for rebates. Learn more

Find a Provider

Search for doctors, clinics, and hospitals in your network at the PEHP Provider Search. Find a Provider

On-Demand Doctors

Intermountain Connect Care offers convenience and savings to all PEHP members with live, on-demand doctor visits online or by phone.


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