Sick Visit During Well Visit Policy

December 02, 2019 - by Rakesh Chopra MD - in Health

No Comments

As per your health insurer carrier rules, there may be an additional charge for evaluation of additional complaints during “Well Visit/Preventative Visit”.

  1. Be Advised that there may be an additional charge allowed by your health insurance carrier if you ask to have your child evaluated for a complaint or illness during their “Well Visit” or if a new evaluation or further management of chronic problem is needed. 
  2. Examples: fever, ear pain, sore throat, cough, wart removal, acute joint pain, rash requiring work up and/or medication, poorly controlled asthma/allergies, poorly controlled constipation, ADHD requiring medication change, etc.
  3. Every insurance company has different policies/procedures/charges for coverage of a “Sick Visit” during a “Well Child/Preventive Visit” Exam.
  4. Please contact your insurance company or member benefits to clarify the policies/procedures/charges for your specific insurance carrier prior to your appointment. 
  5. If you are unsure of you insurance company’s policy, we can either do just one of the visits or we can do both visits with your understanding that you may be charged an additional fee.  There are a few insurers that do not allow a “Sick Visit” the same day as a “Well Visit”.  In this case, you may need to choose which visit to proceed with that day, and reschedule the other visit as needed.

There are some complaints/illnesses that we may not be able to address during “Well Visits” due to the time required to adequately assess these complaints.

  1. If you are concerned about these issues, you must call ahead to see if additional time can be scheduled to address these complaints during your well visit,  If not, we can schedule a separate appointment to discuss the problem or complaints, or we can discuss the problem complaint during the current visit and reschedule the “Well Visit”
  2. Examples include, but are not limited to: prolonged fevers, acute wheezing/problems breathing, significant illnesses, headaches, abdominal pain, chest pain, dizziness, chronic joint pain, mental health, or behavioral issues.

Share this article

Rakesh Chopra MD


Make an appointment and we’ll contact you.