Sick Visit During Well Visit Policy

Insurance Coverage of a Sick Visit during a "Well Child Care" Exam

An issue arises with insurance coverage of sick care visits done during a routinely scheduled “well child care” examination. It is standard procedure for physicians to bill for “illness” related evaluations which are done during a routine well exam.

For example, if your child is sick with a high fever at the time of the well check, depending on the degree of evaluation involved, we may or may not bill for the evaluation of the fever as a separate insurance event.  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.

Any vaccines not completed at the time of the well visit due to illness will need to be completed at a separate visit. This may require a re-check visit with your provider and may require a copay based on the rules of your insurance. We encourage all families to know as much as they can about their insurance plan, so please check with your insurance company in order to clarify these issues.

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