What is a Check-Up?

The providers at Greenvale Pediatrics strongly agree with the (AAP) American Academy of Pediatrics recommendations that your child should receive regularly scheduled checkups. That schedule is posted on our website.

Insurance companies have changed recently in what they will cover during a checkup. Our billing office has had many calls from parents with questions regarding their bills for charges incurred during a “checkup” that are not covered under routine well care. We have created this “Checkup Primer” to educate families about what is routinely covered at the preventive care visits and what may result in additional charges.

When you bring your child in for their next well check, these are the things our providers will do. These are all billed to your insurance company with a “Well Checkup” code:

During check-ups, all children:

• Measure their height, weight, and head circumference (depending on age) and plot them on our growth chart.
• A body mass index (BMI) is calculated for all children older than 3 years.
• Check their eyes, ears, nose and throat
• Listen to their breathing and their heart
• Check their abdominal area and their lymph glands
• Look at their skin
• Check pubertal staging
• Check their muscle strength, tone and neurological system
• Discuss age related anticipatory guidance
• Discuss safety information
• Discuss nutrition appropriate for age
• Discuss development and growth
• Fill out forms for sports

If you have other non-well concerns during your child’s check-up that require more time and medical evaluation an additional code will be added. This is called a Sick with Well service. We offer this as a convenience so that you do not have to bring your child back in if they are sick at the time of the check-up. This has become the standard of practice in other medical specialties, and we are excited to offer this service too. Due to the addition of this separate code, your insurance company may assess a copay. It is up to your insurance company and your insurance plan as to how this service is covered. Some plans completely pay, others require a separate co-pay (even if there is no co-pay for check-ups), and others do not cover these separated charges at all, considering it a “non-covered item”. These billing issues are between you and your insurance company. Because each plan has very different guidelines, we always suggest you check with your insurer or HR department BEFORE coming to the doctor, so that you will know what is covered and not covered by your plan. Our goal continues to be providing quality healthcare to your child, while complying with AAP recommendations and appropriate billing policies.