Dear Families
At our practice, our goal is to provide thorough, high-quality care for every child at every visit. We want to let you know about an upcoming change in how certain services may be billed during your child’s annual preventive (well-child) visit.
What’s Changing
Beginning soon, our providers will bill an additional evaluation and management (E&M) service when a separate medical concern is addressed during a preventive visit. Well-child visits are meant to focus on preventive care, including growth and development, routine screenings, immunizations, and anticipatory guidance. In the past, we have often addressed additional concerns during these visits without separate charges. However, insurance companies now require more specific documentation and billing when problem-focused care is provided.
Examples of issues that may require additional evaluation include:
- New symptoms
- Injuries
- Behavioral concerns
- Management of ongoing conditions
Insurance carriers consider this care outside the scope of preventative services and require it to be billed separately.
How This May Affect Your Insurance
Most insurance plans cover preventive visits at no cost to you. However, problem oriented services may be subject to copays, deductibles, or coinsurance, depending on your plan.
We encourage you to check with your insurance provider if you have questions about your coverage.
Our Commitment to Transparency
Please know our goal is to always provide thorough, thoughtful care, and not to discourage families from sharing concerns. Addressing additional concerns during a preventive visit can often save you the time of returning for a separate appointment.
We understand billing changes can be stressful and appreciate your understanding as we align with national insurance and coding guidelines.
Please contact our office with any questions, we are always available to explain charges, review visit details and support you in understanding your benefits.
Warmly,
Dover Pediatrics, PLLC