It's fully preventative in my case. I have heart issues (I'm a cardiac arrest survivor) and an echo is recommended every 2 years to spot any possible future issues early.

As to the original question, unfortunately I don't know where you got the idea that all possible preventative healthcare interventions are covered under the "free" rule - ie no out of pocket - but in the US that just isn't a thing - the free coverage applies to the list I posted prior (ie ACA Preventive Care) - its a bunch of consensus primary and secondary preventative primarily screenings and medications that are thought to have the greatest impact on public health.

> It's fully preventative in my case.

Fully preventative is not a term of art either for delivery or billing - but there is a difference in categorization between screening tests given to the entire population (ie colon, mammo) and screening given to those with personal risk factors or family history (LD chest CT, echo for congenital HD), and then further on surveillance for personal history of a pre-disposing condition (ie surveillance echo for prior potential fatal arrhythmia).

This is where it starts to get complicated - but the need for an echo every 2 years is not normal. I can't really divine your specific history from the information given - and it isn't necessary - but a history of cardiac arrest alone is not an indication for serial echocardiography. There are numerous specific circumstances where it is recommended, and then there are the cases where it is not consensus recommended but there is controversy. I assume because your insurance company is willing to touch it at all it falls in the former - but we are way off the ranch here in terms of the scope of routine preventative care/health maintenance.

As to whether it should be this way, probably not. If a surveillance echo is clearly indicated to prevent costly sequelae (unfortunately answering this question isn't nearly cut and dry as most think), then it makes sense that an insurance or public health agency would want to do this. Curious if you know if your indication for serial echocardiography falls under the European guidelines? Maybe move there /s. Is Stanford your only reasonable place to obtain an echo?

Lol you mad bro? He just wants an echo to make sure his heart is beating normally

There are two categories of healthcare right? Palliative and preventative. Which one would an echo be in this case? If he had violent symptoms it would clearly be palliative, but in this case it can only be preventative

> There are two categories of healthcare right? Palliative and preventative.

The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophical discussion is irrelevant.

To your actual question - No, the echo is usually pallative. However, right off the bat I'll say this is an overly reductionist and not terribly useful schema for classifying the delivery of medical care. While it might be good as a way for the general public to think about prevention, it’s way too oversimplistic to be useful beyond that.

An aside, palliative has a specific and different meaning within medicine: roughly, treating symptoms without a goal of cure. Reducing a broken arm or removing an inflamed appendix is not palliative care in that sense.

But even if we widen the scope of palliative to be treatment an echo would be neither. An echo is diagnostic - it doesn’t prevent nor treat heart failure or disease. Often when an echo is ordered it leads to some form of treatment for some found disease, in which case if we’re going to stick to the simple classification would be “palliative” - we’re using it to guide treatment, we can’t prevent something that we already see.

> If he had violent symptoms it would clearly be palliative

It's just not that simple. Echos are sometimes used to further evaluate or manage asymptomatic disease, for instance A-fib or a concerning murmur. We're using the echo to rule out suspected coexisting conditions, that's not prevention, and it's not treatment either at that point. Also, echos usually have some symptomatic indication - and they don't have to be violent, whatever that means.

> it can only be preventative

Can you actually think of a disease that an echo would be used to prevent?

But again, in practice we don’t think of delivery of medical care in such grossly general terms - it’s doesn’t simplify in a useful way.

> Can you actually think of a disease that an echo would be used to prevent?

Yes, checking the extent of mitral valve prolapse (which I have, doesn't warrant valve surgery yet but it's expected I may need valve repair in 10-30 years if it gets worse), ejection fraction, early detection of dilated cardiomyopathy (which I'm known to be genetically predisposed to), etc.

Checking the extent of MVP is not really preventing or treating MVP, is it? The echo isn't preventing the mitral valve prolapse, it is also not an intervention - it is a diagnostic tool to guide further intervention. Yes, this could be considered a type of tertiary prevention - but hopefully it should also be clear how this is more usefully classified as diagnostic. Pretty much all medical care is to some extent preventive, even reducing the broken arm - so it becomes a meaningless word if it is loosely defined as any intervention that can potentially prevent sequelae. That means it’s ultimately going to be defined with some restrictive set of criteria. Is the US ACA definition very restrictive, yes, but that’s how it is.

Ejection fraction is not a disease, but let's call it heart failure. An echo evaluating for heart failure is a good example where we can use it as a diagnostic tool to prevent further progression - but again through other interventions - and if we're evaluating for abnormal ejection fraction we haven't prevented it.

Another example might be evaluating for a shunt to prevent stroke. However we don't routinely screen everyone for this.

Echo for inherited cardiomyopathies is a good example of primary or secondary prevention.

There are definitions within medicine that matter for defining appropriate use criteria, but all this preventive vs palliative is arguing loose semantics - the people you’re up against have already put in place the policy to avoid most of that.