Why Am I Being Billed for Blood Work During My Preventive Physical?

While your annual routine physical exam is covered at 100% as preventive care under the Affordable Care Act (ACA), routine blood work and laboratory tests are generally not classified as preventive services.

Because federal ACA guidelines treat most lab tests as diagnostic, they fall under standard plan cost-sharing rules rather than 100% preventive coverage.

Understanding Preventive vs. Diagnostic Services

The primary difference between these two categories determines how your claim is processed:

• Preventive Care: Screenings and exams mandated by federal ACA guidelines to prevent illness or detect conditions before symptoms appear. These are covered at 100% with no out-of-pocket cost.
• Diagnostic Services: Tests, lab work, imaging, or follow-up procedures ordered to investigate specific symptoms, evaluate existing conditions, or monitor health trends. These are subject to your plan’s deductible, copay, or coinsurance.

Note: During a preventive annual exam, your doctor may order lab work based on your discussion, medical history, or physical findings. Even though these tests were ordered during a preventive visit, the labs themselves remain diagnostic under ACA rules.

How to Reduce Your Out-of-Pocket Lab Costs

Your potential savings depend on your specific health plan type:

• PPO Plus Plan: Have your lab work sent to or performed at a standalone Labcorp facility to receive covered lab services at no cost to you.
• PPO Plus HSA Plan: Lower your out-of-pocket expenses by ensuring your provider routes your lab samples to Labcorp. Sana partners with Labcorp to provide discounted, pre-negotiated rates for our members.

Related Resources

• Review our Full List of Covered Preventive Services to see which routine exams and screenings are covered at 100%.
• Use the LabCorp Location Finder to locate a nearby facility or learn more about partner lab services.