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What is a Check-Up?

Greenvale Pediatrics

The providers at Greenvale Pediatrics strongly agree with the (AAP) American Academy of Pediatrics 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” 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.

When you bring your child in for their next well check, these are the things our providers will do. These are all billed to your insurance company with a “Well Checkup” code:

During check-ups, all children:

  • Measure their height, weight, and head circumference (depending on age) and plot them on our growth chart.
  • A body mass index (BMI) is calculated for all children older than 3 years.
  • Check their eyes, ears, nose and throat
  • Listen to their breathing and their heart
  • Check their abdominal area and their lymph glands
  • Look at their skin
  • Check pubertal staging
  • Check their muscle strength, tone and neurological system
  • Discuss age related anticipatory guidance
  • Discuss safety information
  • Discuss nutrition appropriate for age
  • Discuss development and growth
  • Fill out forms for sports

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 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 separated charges at all, considering it a “non-covered item”. These billing issues are between you and your insurance company. Because each plan has very different guidelines we always suggest you check with your insurer or HR department BEFORE coming to the doctor, so that you will know what is covered and not covered by your plan. Our goal continues to be providing quality healthcare to your child, while complying with AAP recommendations and appropriate billing policies.