Well-child visits (or physicals) are important, even when children are healthy.
What is a Check-up?
All of the Pediatricians at our office agree strongly with the AAP 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” or “well child visit” 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. We do not determine how your insurance company decides how many of these visits to “cover” each year. We also do not determine if you have a co-pay for your child’s “well child” exams. That is between you and your insurance company.
When you bring your child in for their next well check, these are the things we will do. These are all billed to your insurance company with a “Well Checkup” code:
- Measure their height, weight and head circumference (depending on age) and plot them on a growth chart. We will calculate a body mass Index (BMI) for all children over 3 years of age.
- Review your child’s vaccine status and recommend any vaccines needed and discuss that with you and your child
- Check their eyes, ears, nose, throat
- Listen to their breathing and their heart
- Check their abdominal area and lymph glands
- Look at their skin-evaluate moles, etc.
- Check their genitals and pubertal staging
- Check their muscle strength
- Discuss age related anticipatory guidance
- Discuss appropriate safety issues for their age
- Discuss nutrition appropriate for age
- Discuss their development and growth
- Discuss their schooling-both academically and socially
- Discuss any family issues or family concerns
- Discuss with teens, use of drugs, alcohol
- Fill out school or sports forms at that visit
- Refill medications for any chronic problems-like acne, asthma, etc.
- Review any chronic problems like asthma, allergies, eczema, etc.
Other concerns that are more time involving and thought provoking such as chronic (prolonged duration) headaches, chronic stomach pains, psychological problems, or other more involved medical issues may not be able to be handled at the time of this visit due to time constraints. We may even ask you to make a new separate appointment to handle these other concerns when we have more time to handle them completely.
If it is handled at this visit, it will usually get coded with a separate code from our check up. Due to this separate code, there is an additional visit charge. It is up to your insurance company and specifically your medical plan as to if and how they will pay these charges. 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 separate charges at all, considering it a “non-covered item.”
These billing issues are between you and your insurance company, and we always suggest you check with your insurer BEFORE coming to the doctor to know just what is covered and what is not by YOUR plan. Each plan has very different guidelines. Each insurance company covers a different number of ”well child” exams per year. Insurance companies are really getting tricky these days with their hidden costs. Please make sure you know up front, so there will be no surprises.
Well Check-ups for Teens
In addition to caring for your teen when he or she is sick, we also want to see your teen for regular well visits (checkups). Well checks focus on keeping your teen healthy and are usually recommended every 1 to 2 years.
We will check your teen’s growth and development, do a physical exam, and perform recommended screening tests. We will review your teen’s immunization records and make sure he or she is up to date with all recommended shots.
Teens have a growing need for independence and privacy, so we will want to see your teen alone for at least part of the checkup visit. Most teens (and adults) have an easier time sharing information with their medical professional in private. Teen well checks are also an opportunity for us to talk about how your teen is developing socially and emotionally, and how things are going for your family.
If you have any questions or concerns, please don’t hesitate to discuss them with us. Together, we can work to keep your teen healthy.
Suggested Well-Visit Schedule
Here is a list of vaccines/screening we recommend at the visits.
| Age | Vaccines | Labs/Tests |
| 2 months | Pentacel #1, Prevnar #1, Hep B #2, Rotateq #1 | |
| 4 months | Pentacle #2, Prevnar #2, Rotateq #2 | |
| 6 months | Pentacel #3, Prevnar #3, Hep B #3, Rotateq #3 | |
| 9 months | ||
| 12months | MMR #1, Varivax #1, Hep A #1 | iScreen |
| 15 months | DTaP #4, Hib #4, Prevnar #4 | |
| 18 months | Hep A #2 | hgb, PEDS |
| 24 months 30 months | MMR #2 | M-CHAT |
| 3 years | Varivax #2 | iScreen |
| 4 years | Quadracel | |
| 5 years | Vision, Hearing | |
| 6 years | Vision, Hearing | |
| 8 years | Vision, Hearing | |
| 10 years | Tdap, HPV #1 | Vision, Hearing |
| 11 years | MCV 4 #1, HPV #2 | |
| 12 years | Vision, Hearing Lipid panel | |
| 14 years | Vision, Hearing | |
| 16 years | MCV 4 #2, Bexsero | Urine screen (GC/Chl) |
| 18 years |
*If your child has a chronic illness, we recommend a check-up every year. Additional vaccines may be recommended if your child is delayed in receiving vaccines.*
