Patient Bill of Rights: The patient has a right to considerate and respectful care. Patients have the right to obtain from their physician complete and current information concerning their diagnosis, treatment, and prognosis in terms they can be reasonably expected to understand. An informed consent should include knowledge of the proposed procedure, along with its risks and probable duration of incapacitation. In addition, the patient has a right to information regarding medically significant alternatives. The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his/her actions. Case discussion, consultation, examination, and treatment should be conducted discretely. Those not directly involved must have the patient’s permission to be present. The patient has the right to expect that all communication and records pertaining to his/her care should be treated as confidential. The patient has the right to obtain information as to the existence of any professional relationships among individuals, by name that is treating him/her. The patient has the right to be advised if the facility proposes to engage in or perform human experimentation affecting his/her care or treatment. The patient has the right to refuse to participate in such research projects. The patient has the right to expect reasonable continuity of care. The patient has the right to examine and receive an explanation of his bill regardless of the source of payment. The patient has a right to know what facility rules and regulations apply to his/her conduct as a patient.
Privacy Policy (HIPAA): All patients and their families should feel confident and secure that their protected health information is handled with the utmost professionalism and confidentiality.
Billing for Well-Child Visits and Sick Visits: The services provided as part of a well-child checkup are generally defined by the health insurance company. These checkups include an assessment of growth and development, screening for medical and psychosocial problems, anticipatory guidance to aid parents in the next stage of their child’s development, a review of your child’s vaccination history and status and administration of any vaccines necessary.
Sometimes, a more significant health problem will be identified over the course of this visit. If so, the time and effort spent addressing these concerns go beyond the scope of what is covered by a well-child exam. Some examples include:
A new problem that requires diagnostic testing, referral to a specialist or sub-specialist, significant change in treatment for an existing concern, or prescription of a new medication. For example, at a 9-month baby visit, baby Frank is weighed and measured and is found not to have gained weight appropriately. Lab testing is done to check for anemia and a special feeding plan is set up.
An in-depth discussion of a chronic medical issue that requires a detailed review of the existing treatment plan, and/or a change in treatment or a new diagnostic workup. For example, young Katy has congenital hypothyroidism and is on thyroid hormone replacement. Her recent labs are reviewed and her growth is assessed and a change is made to her medication. She is also referred back to Endocrinology for follow up.
When a scenario like one of these arises, your doctor will typically submit billing codes for both a well-child visit and a problem/sick visit. That indicates that an illness or problem was treated in the same visit. This is standard billing practice among all primary care providers and is accepted as standard practice by government agencies and by private health insurers. While most plans cover preventive care in full with no co-pay, there is often a co-pay, co-insurance or deductible associated with the add-on sick visit billing code.
It is important to review chronic health conditions, so we encourage you to schedule this visit separately, if possible.