Well visits

A combined care visit occurs when your child’s well-child exam is combined with the evaluation of an additional medical concern during the same appointment. For example, if your child is scheduled for their annual physical but also has an ear infection, rash, or ongoing concern that needs to be addressed, both may be handled during a single visit. This is a convenience that allows your child’s provider to efficiently address concerns that might otherwise require you to schedule and attend a separate appointment. 

Well-child visits are considered preventive care and are typically covered by insurance at no cost to you. However, if your child’s provider evaluates or treats a separate medical concern during the same visit, that additional service may be billed as a problem-focused or evaluation and management visit.

This additional service may be subject to copays, deductibles, or coinsurance depending on your insurance plan. This billing reflects the additional time, medical decision-making, and complexity involved in addressing concerns beyond the preventive exam. 

Preventive services typically covered as part of a well-child visit include: a conversation about your child’s medical history (including social and family history), height and weight screening, age-appropriate immunizations (based on your plan’s coverage), developmental and behavioral screenings, a routine physical examination, and preventive health counseling such as nutrition and safety guidance. 

Additional billing may apply when your child’s provider evaluates or manages concerns beyond the preventive exam, such as new symptoms (fever, cough, rash, ear pain), chronic or ongoing conditions (asthma, allergies, ADHD), medication concerns or prescription refills, behavioral or mental health evaluations, and certain specialized screenings (autism evaluations, adolescent depression screenings, etc.) that fall outside your plan’s preventive coverage. 

Most insurance plans cover the preventive portion of a well-child visit at no cost. However, coverage for additional problem-focused services varies by plan. We recommend contacting your insurance provider directly to understand your specific benefits, including any copays, deductibles, or coinsurance that may apply to non-preventive services. 

Absolutely. If you prefer to keep your visit focused on the preventive exam only, you can let your child’s provider know. Any additional concerns can be scheduled as a separate follow-up appointment. However, many families find it more convenient to address everything in one visit rather than making an additional trip to the office. Your provider will always prioritize your child’s health and safety, so if a concern requires immediate attention, they will discuss this with you. 

If you have questions about charges from your child’s visit, please contact our billing department by calling 949-599-2434. Our team can help explain the services billed, assist with insurance questions, and work with you on any concerns. You can also contact your insurance provider directly for details on your specific plan’s coverage.