Understanding Your Wellness Visit
In an effort to optimize the health of our patients, Elmwood Pediatric Group recommends regular well child care visits (physicals) from birth through college. This document is provided to help patients understand the difference between what is covered within a Well Child Visit vs. Problem/Sick Oriented Visit.
The Benefits of Well-Child Visits
- Prevention. Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.
- Tracking growth and development. See how much your child has grown in the time since your last visit, and talk with your doctor about your child’s development. You can discuss your child’s milestones, social behaviors and learning.
- Raising concerns. Make a list of topics you want to talk about with your child’s pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.
- Team approach. Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.
Well-Child Exam Schedule
- 1 month
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months
- 24 months
- 30 months
- 3 years
- Annually after 3 year exam
Insurance Coverage for Well Child Visits vs. Problem/Sick-Oriented Visits
You are likely aware that the health care reform changes have directed that your insurance company no longer apply a co-pay and/or charges toward a deductible or co-insurance for many well child and preventative services. Although most well child visits are charge-free, this is not true of problem-oriented services provided during a well child visit. Some common examples of problem-oriented services include:
- Ear infections
- Nasal congestion
- Sore throat
- Removal of ear wax
- Wart treatment
- E.D. follow up
- Prior visit concerns
We do strongly encourage that these seemingly minor issues receive due attention.
Insurance company billing policies dictate that we differentiate between these two types of services. Evaluation and management of any complaint or symptom offered by a patient or identified upon questioning during a preventive exam constitutes a problem-oriented service as well. Problem-oriented services always require a co-pay/co-insurance/deductible, if applicable to your insurance plan.
Well child visits may uncover or revisit problem-oriented issues that require evaluation or management. It is our preference whenever possible to go ahead and address such problem-oriented issues at the same office visit (unless the patient desires to return at a later date to address the problem-oriented issues.) In compliance with insurance company billing policies, this then prompts charges for both categories during the same visit. As a result, services are performed that are both preventative physicals and problem/sick-oriented in nature and can result in a co-pay/deductible/co-insurance.
Screening– Services provided at well child visits allow us to screen for many medical conditions such as:
- Developmental delays
- Appropriate height and weight gain
- Hearing and vision problems
- Inhaler/Nebulizer training asthma
- Epipen training for allergies
We also review appropriate immunizations which allows us to begin treating/preventing any condition in its earliest stages. During these visits we perform all AAP (American Academy of Pediatrics) recommended screenings appropriate to age and gender and seek to diagnose any conditions that may lead to suboptimal health in the years to come. Most insurance companies cover these services but a small minority do not. Please check with your insurance carrier to understand what screening services are covered by your insurance plan.