News and Notes

We are a PCMH practice.

Updates on Billing Requirements at Pediatric HealthCare 2/8/25

 
Our practice is responsible for billing you and your health insurance company appropriately for your well and sick/problem-based visits.   
 
Your child’s annual well/preventative visits are dedicated to monitoring the growth and development of your child and discussing ways to maintain their health for the long term.  This may include discussing lifestyle choices, reviewing screening tests (such as screening for nutritional deficiencies and heart health), evaluating sports health, reviewing anticipatory guidance, and offering vaccines. 
 
Often during these visits, patients also want to discuss new or chronic health issues/problems. We will try to accommodate those issues during the preventative visits when possible.  In these cases, you will then see two charges for that visit: one for the wellness visit, one for the problem-focused visit.  In this case, your insurance may require you to pay a copay or deductible for one or both parts of that visit.  Combining the two visits together may save you from returning on another day to discuss the problem-based issues.  
 
Our office is responsible for submitting the appropriate codes based on the type of visit your child had and the issues managed at that time.  Our billing department will submit to your insurance company the services reported for the visit.  These service codes cannot be changed and must accurately reflect the care your child received.  For questions and concerns, we ask that you review your insurance plan and/or reach out to your insurance provider.