One of the top questions asked of our Billing Department is "Isn't my child's annual well child check-up free?".
While some insurances list in their plans that their members are allowed one free well exam a year, it does not necessarily mean you are guaranteed a visit without receiving a bill. To prevent the surprise of receiving a bill for your annual Well Child Check-up (WCC) there are a few things parents should know:
1) Understanding your plan/policy is the key to understanding what your insurance will and will not cover.
There are policies that will cover one general well exam a year, but in that exam they will not cover eye exams, labs such as a cholesterol screenings, behavioral screenings and sometimes even vaccines. These are all charges that can be sent to your insurance depending on the age and health of your child, that may or may not be covered by your particular policy.
Never assume that because you are insured that your plan will cover your annual well exam or well baby exams at 100%. Be sure to ask your insurance the right questions and read the policies and coverage you are paying for.
2) Parents also need to take into account what the child is being seen for during their annual Well Child Checkup (WCC).
If a parent schedules their child's annual WCC and then asks that the child being seen for additional reasons such a consultation or a renewal in their ADHD medication, this visit may go beyond what your insurance considers a WCC.
Being seen for asthma or ADHD during your child's WCC are common reasons why patients end up with a co-pay. Also, keep in mind that if a child is coming in for a WCC and there are other findings that go beyond a well child checkup (such as an ear infection, allergies or eczema), there is the possibility that the child’s visit will result in a co-pay.
3) The best thing a parent can do is to be aware, and never assume when it comes to your insurance.
Always feel free to contact our Billing Department at (703) 322-0245 with any questions, and we will be happy to help you in any way that we can.