Due to all of the recent changes in the health care industry, our billing department receives many calls from parents with questions regarding their bills and charges incurred during a “routine well visit” or “office sick visit.” We have developed this informational sheet to help our families better understand this often confusing billing process.
- KNOW YOUR INSURANCE PLAN– check your insurance policy for benefits such as:
- Does your plan cover Well Care visits?
- For NEWBORNS- how many well visits does it cover in the baby’s first year?
- What is your coverage regarding other office or sick visits?
- Are there restrictions to vaccine coverage?
- What is your primary care copay & deductible?
- Does your plan cover in office labs?
- Does your plan cover after hours care?
- Does your plan require a year+1 day between annual well exams or are you covered once per calendar year?
If you have any change in your insurance coverage, it is important to update us with this information as soon as possible. Insurance cards also will be requested at each visit.
Please make sure that you add your newborn to your insurance policy within 30 days of birth. Per your insurance contract, this is your responsibility. Have your carrier backdate your baby’s coverage to the baby’s birth date.
INFANTS– We follow the American Academy of Pediatrics guidelines and would like to see your newborn 1-3 days after hospital discharge. Your physician will ask how your baby is feeding, check weight and hydration, evaluate for jaundice, and discuss other important newborn concerns and questions. This visit is an important one! Copays and/or deductibles may apply to this visit depending on your insurance carrier.
Routine well visits are typically performed at 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, and often 30 months. All other visits are billed as an “office sick visit.” During checkups for children, we perform the following:
- Height, weight, and head circumference (depending on age) are measured and plotted on a growth chart. Hearing and vision screenings are performed as recommended. Blood pressure and pulse are recorded for all children 3 years and older.
- A body mass index (BMI) is calculated for all children 3 years and older.
- Vital signs and growth data are evaluated and a complete physical exam is performed.
- Developmental milestones, education, nutrition and safety issues are discussed in an age-appropriate fashion. This includes some private time with our adolescents.
- Recommended vaccines and screening labs are administered.
- Forms for daycare/school/sports are completed.
As your child’s primary care provider, we feel it is important to spend time at your child’s well visit to do a comprehensive review of any ongoing medical issues and to address any new concerns or acute illnesses. This might include monitoring chronic abdominal pain, headaches, learning or behavioral problems, asthma, and ADHD, for example. It might also include treating an infection diagnosed that day. Evaluating and coordinating care for these additional medical issues during the well visit is very important and may result in a second billing code in addition to the well visit code. Therefore, you may see a charge for an office visit, in addition to the well visit. Your insurance company might apply a copay and/or deductible for the “office/sick visit” component, depending on your coverage. We are happy to address all of these issues with you while you and your child are already in our office for the well visit. If you would prefer, we will schedule a separate visit to address any ongoing medical conditions or acute illnesses.
Please feel free to call our billing office with any questions at 508-429-2800 x 3804 or x 3820. We are here to help. We thank you for choosing Holliston Pediatrics as your child’s medical home.