1. I thought well-child visits were covered at 100%. Why am I getting a bill?

We do our best to address your child’s health needs during every visit, including regularly scheduled well exams. Most insurance plans cover important preventive care discussions and screenings as part of the exam. When we address an illness or problem (like an ear infection or rash) or help manage a previously diagnosed health problem (like asthma or ADHD), it is not considered preventive care and insurance companies may not include that in preventive coverage. If this happens, you might have extra costs added on as in an additional office visit for illness.

Tests, procedures, or discussions to diagnose or treat health problems are not considered preventive care at a well exam, so you may get a bill later. Here are some examples of non-preventive care you could receive during a well visit that may have an additional cost:

  • Discussing new symptoms
  • Discussing illness or conditions
  • Unplanned procedures
  • Treatment or testing for new/existing conditions
  • Medication management (e.g., ADHD, asthma)

2. What care is included in a well-child visit?

We follow the American Academy of Pediatrics Bright Futures Guidelines for pediatric preventive care. These recommendations include:

  • A physical exam to check your child’s overall health and development.
  • Developmental screening to assess your child’s progress in reaching important milestones.
  • A vision screen to check for any vision problems.
  • Immunizations to protect your child from preventable diseases.
  • Fluoride varnish to help prevent cavities.
  • A lead level test to check for lead exposure.
  • A hemoglobin test to check for anemia.
  • A lipid panel screen to check for high cholesterol or other heart disease risk factors.
  • An STD/HIV screen for adolescent patients.

**These services are not always provided at each visit, but rather on a standard visit schedule based on your child’s age.

Some health plans do not cover all the recommended screenings, even though they are the national standard of care. Please call your insurance company to check your benefits.