Thank you for trusting ENC Peds PLLC with your child’s care. We know there’s often confusion about the different types of visits we offer and how they are billed. Even if your insurance plan covers your visit to us, you may be responsible for cost-sharing expenses, such as co-pays, co-insurance and deductibles. We hope the information below is helpful.
General Office Visit Instructions:
1) If you have signs and symptoms of a possible respiratory infection (e.g., a common cold or allergies), please ring the doorbell and wait outside or call to check in from your car.
2) Once you check-in, you will receive a pager to alert you when you can come into the office; please wait in your car.
3) To protect our patients and staff, please have everyone in your group wear a mask.
Symptoms of a respiratory infection can include:
– Cough
– Fever or Chills
– Sore throat
– Runny nose
– Congestion
– Headache
– Unexplained tiredness or lack of energy
– Muscle aches or pains (that are not due to exercise)
– Loss of or change in your normal sense of taste or smell
– Shortness of breath (Breathlessness, tight chest, or wheezing)
– Loss of appetite
What is included in a well visit?
A preventive visit — also called a well visit — is a scheduled check-up focused on keeping your child’s whole body healthy and safe. These checkups are recommended for infants, children and teens. Kids need one preventive visit every year from age 3 through age 21; babies and young toddlers need them more frequently. These appointments can include preventive care like:
– A general physical exam – This includes measuring height, weight and blood pressure, and other age-specific growth and development checks.
– Age-specific immunizations (vaccinations) such as chicken-pox, measles, whooping cough, hepatitis, etc.
– Age-specific screenings, such as hearing and vision screenings.
These visits are typically covered by your health insurance, often at no cost to you. Some of the specific tools used during screenings may be billed separately.
What is a sick (office) visit?
This type of visit is made when your child is having a specific health problem, illness or injury, or for management of chronic, ongoing health problems and/or medications. Reasons for this type of visit can include:
– Illness such as the flu, strep throat or an ear infection
– Injury
– Anxiety/depression
– ADHD management
– Other chronic condition
There is usually a cost for this type of visit. Your insurance provider may pass some or all of the costs to you. You may be responsible for a copay, co-insurance or deductible.
Can I be charged for both types of visits?
Sometimes at a well visit, an issue comes up that’s not part of the regular check-up but that needs to be addressed during that visit. Your provider could address a problem to manage a condition or illness and may prescribe medication, order additional tests like lab work or X-rays, or refer you to a specialist.
In these cases, insurance requires us to bill the visit as both a well visit and a sick (office) visit, so you will likely have to pay an additional co-pay or co-insurance, or the cost will be applied to your deductible.
Explanations adapted from “https://www.chop.edu/health-resources/annual-well-visits-vs-sick-visits-know-difference“