There is a misperception that one can get as many things seen as possible during a physical or well child visit. The best way to understand how this works is to compare seeing a doctor with getting your car fixed. We do not like the analogy, but there are similarities. Getting a tune up on your car is similar to a preventive visit. If your mechanic finds a problem, he or she will fix it for a charge above and beyond the tune up charge. It is the same for a physician. A preventive visit covers screening and assessments of your child’s development. Addressing issues and concerns are not part of the preventive visit and are handled the same as a problem found with the car.
It is impossible for your provider to know the details of your insurance plan. Each employer that offers health insurance to its employees has a unique contract with the health insurance company. Thus, there are thousands of subtle differences even within the same insurance carrier. Even your insurance will not guarantee coverage prior to the claim being processed. If you hear a provider say something like “I think it’s covered” or “your insurance should cover this” don’t believe them. They don’t know. If you have questions regarding your insurance plan our billing staff would be happy to assist you in contacting your insurance to check your benefits, but your insurance will make the final coverage determination when they process your claim.
If your provider asks you to follow up after an initial visit, there may or may not be a charge for that visit. If you have concerns, ask if you will be charged for the follow up visit. There are many situations when the provider will need to see your child again. Some of those reasons may require a visit charge.
If you come in with a long list of items to address, it is highly likely that the provider will not be able to address all of the items in the allotted time or there may be additional charges. For example, if you schedule an appointment for a sore throat but in the exam room ask that the provider remove a wart, the wart removal is considered an additional service.
Some procedures (fractures, lacerations, etc.) are charged on a global basis. This means that the upfront charge also includes a period of subsequent care associated with the original condition, as long as the provider seen for the first visit is seen for all subsequent visits. For example: if your child has fracture repair, all follow-up care surrounding the fracture (including cast removal) is included in the upfront charge if the same provider is seen. If another provider removes the cast or provides follow-up care there are usually additional charges involved.
When the pediatrician examines your child in the hospital, they may not always have the chance to visit with you about your child’s exam. Even if you don’t personally see the pediatrician, be assured that your child has been examined each day they are in the hospital, per hospital requirements. These services will be billed.
Because of the busy schedule, the provider may or may not have time to see a child who is not scheduled to be seen. If the provider does have time, there is a possibility that the unscheduled child will receive a separate visit charge. Depending on your insurance, this may also require an additional co-pay.