Sick Visit During Well Visit Policy

Insurance Coverage of a Sick Visit during a "Well Child Care" Exam



A patient’s preventative well exam only includes certain services. The services included in this visit are preventative in nature and do not include diagnostic care.

Generally covered in preventative visits:

• Routine physical examination including vital signs
• Discussions regarding preventative care including general health, immunizations, etc.
• Refilling prescriptions that are NOT changing

Generally NOT covered in preventative visits and billed separately:

• Discussion with your provider regarding any new, worsening, or ongoing symptoms that your provider needs to diagnose and/or treat with additional testing, more extensive physical examination, lab work or new or changing medications

This may include, but is not limited to, abdominal pain, headaches, behavioral or mental health concerns, or changes in medications. Based on how extensive the concerns are, a provider may need to schedule a separate appointment in order to assure adequate time to address. If the provider can address at the wellness visit, please be aware that a separate charge will apply.

All services may be subject to copay, deductible, and/or co-insurance with your insurance plan. It is your responsibility to understand what is covered under your insurance company’s wellness benefit.