• Amelia Colley, M.D., FAAP
  • Philip Dawson, M.D., FAAP
  • Scott Iwashyna, M.D., FAAP

9606 Patterson Ave., Richmond, VA 23229
(804) 740-6171 office | (804) 741-3105 Fax
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Well Care Visits and CoPays

                                                        WELL CARE VISITS AND CO-PAYS

As you may be aware, as of September 26, 2010, The Affordable Care Act mandates that insurance companies cover the physical exam portion by the doctor for preventive (well) services at 100%, effective upon the re-enrollment in each plan (except for Military or Grandfathered Plans.)  This means that no payment is due from you, the parent/guardian of the patient, for the physical exam portion of the physician’s visit for Preventive, Well Care.

During the Preventive, Well Care visits the following items are included, which are considered customary and reasonable with respect to parental concerns and time involved and with respect to your individual policy with your insurance carrier:

  • Medical History

  • Discussion of normal nutrition and feeding/eating

  • Obesity screening (Counseling takes additional time, and is billed accordingly.)

  • Discussion of elimination (bowel and bladder issues, toilet training)

  • Discussion of sleep and sleep issues

  • Developmental screening throughout childhood

  • Discussion of normal development for age (Discussion of abnormal development  takes additional time, and is billed accordingly, and may require a separate visit)

  • Discussion of normal behavior and discipline for age. (Discussion of abnormal behavior takes additional time, may require a separate visit and is billed accordingly)

  • Discussion of School (if applicable) and normal interaction with family and peers

  • Alcohol and Drug Use screening for adolescents (CRAFFT Questionnaire).  This is a separate billable screening document.

  • Depression screening for adolescents (PHQ2 Questionnaire) (treatment at separate visit).  This is a separate billable screening document.

  • Full physical examination

  • Oral Health risk assessment for young children, and fluoride varnish if younger than age 3.  This is a separate billable screening procedure.

  • Measurement and Discussion of growth

  • Iron supplements for children ages 6 to 12 months at risk for anemia

  • Blood Pressure screening for children

  • Dyslipidemia screening

  • HIV screening for adolescents at higher risk

  • Lead screening for children at risk of exposure

  • Tuberculin testing for children at higher risk of tuberculosis.  This is a separate billable screening procedure, if needed.

  • Discussion and administration of vaccines as needed up to age 18 years

Occasionally, in the course of a normal well child visit, there may be other concerns voiced by the parent/guardian regarding a potential medical illness or condition.  Likewise, the physician may during the course of the encounter by history or by physical examination, find an abnormality that requires further investigation.  This may include, but is not limited to, ear infection, poor weight gain, rash, developmental delay, behavior/school/learning problems, an upper respiratory infection etc. These diagnoses may, and usually do, require further time to fully evaluate and discuss.  Occasionally a prescription may need to be written, a medical work-up may need to be instituted or a referral made to a specialist. They would normally require you to make an additional office visit to address; however, in the interest of expediting treatment, our Practice will attempt to offer comprehensive medical services at each well visit, and we will try to avoid requiring a separate office visit to evaluate these additional diagnoses observed during the well visit.

However, please understand that the doctor is legally mandated by the insurance company to code and charge for all additional diagnoses and procedures other than “well child” as described above, as additional time is needed to cover these additional topics. Physicians are also required to code all diagnoses observed or discussed in every visit, including the well visit.  

Your insurance company will process the sick visit according to your benefits.  This may result in a co-payment or the visit may be applied to your deductible, both of which are your responsibility.  Co-payments and deductibles for the additional diagnosis may or may not be collected at the time of service as determined by how the insurance company defines your benefits (and need to pay a copay/deductible).  You may, at a later date, receive a statement in the mail for any additional payments required for this additional office visit if it is not covered in full by your insurance company.  Please contact our Accounts Department if you have any questions about your statement or your account.

Also, you may be responsible for cost share for some well child visit screening tests, or other services that may be offered for your child, depending on your insurance. These will be collected at the time of the visit during checkout.

Please go to www.healthcare.gov  for more information about the Affordable Care Act and how it affects you and your family.

                                THANK YOU FOR YOUR UNDERSTANDING AND SUPPORT!