Insurance Update

Dear Families:

Insurance coverage changes constantly and we wanted to inform you of two significant areas that might help you understand the billing process in advance of your visit today.

ALTERNATE VACCINE SCHEDULES:

If you should choose an alternate vaccine schedule for your child, please be aware that your insurance company may not reimburse you for the vaccinations if they are not done at the same time that the “well care visit” is performed. You may be charged a copay for returning, and in many cases they do not pay for the vaccine administration fee or even the vaccine itself. In all cases, whatever the insurance company does not pay for on your return visit for vaccinations will be your responsibility. We encourage all families to know as much as they can about their insurance plan, so please check with your insurance plan before proceeding.

INSURANCE COVERAGE OF A SICK VISIT DURING A “WELL CHILD CARE” EXAM

The second issue arises from insurance coverage of sick care visits done during a routinely scheduled “well child care” examination. It has always been an acceptable billing practice for physicians to bill for “illness” related evaluations which are done during a routine well exam. For example, if your child has been suffering from migraine headaches and you ask about them at the well exam, depending on the degree of evaluation involved, we may bill for the evaluation as a separate insurance event. We are often willing to do a limited sick evaluation, e.g., an ear infection at a well care without billing for it. However, at the discretion of the provider, we reserve the right to bill for our time if the complexity or time spent warrants it. This is not a new billing procedure. What is new is that, depending on your insurance plan, this visit may fall under a deductible or co-insurance, which would then be your responsibility. Please be mindful of this process when planning your “well child care” visits.