For example, checking your child's growth, getting routine immunizations, and checking developmental milestones are standard from birth to 5 years old. The problem is that insurance companies have very clear guidelines about what constitutes a preventive visit, which is how a well-child visit is billed versus what is billed under 'E&M coding or evaluation and management coding.'Įvery insurance company has their own guidelines, but there are some things that are standard across the board, and these are set based on recommendations from the American Academy of Pediatrics and the Affordable Care Act. And sometimes they want to discuss behavior concerns, evaluate for ADHD or depression. I'll have parents come in for a well visit, but then they'll also want me to refill medications or discuss headaches or stomach aches that their child's been having. Gellner: When a parent brings their child in for a well visit, often they want their pediatrician to address other issues. You are now entering 'The Healthy Kids Zone' with Dr. So why are you getting a bill?Īnnouncer: Keep your kids healthy and happy. Well visits are covered 100% by most insurance companies. Gellner: So you take your child in for a well visit, but then you get a bill from your pediatrician's office. In addition, the percentage of non-wellness visits with associated preventive services increased approximately 60%, from 1.8% in 2006 to 3.7% in 2018 (coefficient on linear time trend: 0.09 percentage points 95% CI, 0.03-0.15 P = .005).Dr. The percentage of wellness visits with an associated out-of-pocket cost declined from 54.2% in 2010 (the year that the ACA was passed) to 14.5% in 2018 (coefficient on linear time trend: −5.63 percentage points 95% CI −6.96 to −4.31 P < .001) ( Figure, C). Older children had office visits or outpatient care without a wellness visit at higher rates than younger children during the study period ( Figure, A). The volume and relative share of total visits per child (coefficient on linear time trend: 0.01 visits 95% CI, 0.01-0.02 P = .03) and wellness visits per child (coefficient on linear time trend: 0.02 visits 95% CI, 0.01-0.02 P < .001) remained stable over time ( Figure, B). The proportion of children with at least 1 office or outpatient visit and without a wellness visit declined from 39.3% in 2006 to 29.0% by 2018 (coefficient on linear time trend: −0.79 percentage points 95% CI, −1.11 to −0.47 P < .001) ( Figure, A). The sample consists of 88 863 727 person-years from privately insured children in 48 states, with a total of 371 573 184 visits across the study period from 2006 through 2018 ( Table). Data were analyzed from June 10, 2020, to January 15, 2021, using SAS, version 9.4 (SAS Institute, Inc) and Stata, version 16 (StataCorp). P < .05 was considered to be statistically significant, all P values were 2-sided. We plotted the trends over time and tested for significance using linear regression. We examined trends in visit volumes to ensure that compositional changes did not explain the findings and assessed the delivery of preventive services during non-wellness visits. 4 Diagnosis codes from the International Classification of Diseases, Ninth Revision (visits before October 2015) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (visits in October 2015 and after) and Current Procedural Terminology and Healthcare Common Procedure Coding System codes used to identify preventive services were obtained from the Centers for Disease Control and Prevention and were supplemented with coding guidelines from major insurers. We stratified the sample by 2 age groups (0 to 5 years and 6 to 17 years) because these groups have a different recommended frequency of visits for wellness and other preventive services. We focused on 2 outcomes: the proportion of children who had an office or outpatient visit without a wellness visit and the proportion of wellness visits resulting in an out-of-pocket cost, which were calculated annually during the study period.

We used health insurance claims from 2006 through 2018 from children aged 0 to 17 years with full-year coverage each year claims were obtained from the IBM MarketScan Commercial Claims and Encounters Database.

We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE) reporting guideline. This cross-sectional study was deemed exempt from review, and the requirement for patient written informed consent was waived by the Boston University Institutional Review Board because deidentified data were used.

Well baby visits costs