What Should You Expect
Do you know what a Well Visit covers? We have found that there are as many different interpretations as there are patients and very few are correct. This is due to the world of insurance. Insurance dictates what will be covered in a well visit and what would be considered additional care.
An annual Well Care Visit is considered Preventive Medicine visit as defined by the AMA. It is an Initial (new patient) or Periodic (established patient) comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions and the ordering of lab/diagnostic procedures. The counseling, guidance, risk factor reduction must be tied to the examination and the cover areas of health based on nutrition, exercise and normal physical development.
Insurance coverage does not include counseling, risk factor reduction interventions not provided with a preventive medical exam. In other words, if the issue does not fit within the actual preventive care exam, you may incur an additional charge. Don't be afraid to ask your provider if your topic/question is covered under the Well Care exam. You can choose to continue to discuss the topic or chose to make another appointment. Either option will be charged the same.
Even if your doctor has asked about any concerns or questions you may have, or brings up problems they might find; if your topic is out of the realm of the well exam based on insurance, requires additional time, referral or testing, it will be coded as such and that is what determines the additional charges if any.
Why Does Your Child Need Annual Physicals
Childhood is a time of rapid growth and change. Your child will have more pediatric Well Child visits when they are younger and developing fastest.
After you baby is born, your first visit should be with in 2-3 days after being discharged. After that, it's recommended that visits occur at the following ages:
2 mos, 4mos, 6mos, 9 mos, 12 mos, 15mos, 18 mos, 2 years and yearly after that until the age of 18.
At each well exam, the provider check's the child's growth and development in order to find or prevent problems. Hearing, vision or other tests may be performed at specific visits.
Even if your child is healthy, these visits are extremely important, because it is a good time to focus on your child's wellness.
Sports Physical vs Well Care Visit
As your child reached middle school age, schools require a "sports physical" in order to participate in the school sponsored athletic activities. The exam itself is exactly the same. However, depending on the school district depends on when the exam must be completed. Please consult with the school to acquire the form and earliest date the exam can take place to be accepted.
If the exam is done prior to that date, the school will not accept it and insurance may not cover that visit and charges could apply.