Well Visits vs. Sick Visits – Know the Difference
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Thank you for trusting Children’s Hospital of Philadelphia (CHOP) with your child’s care. We know there’s often confusion about the different types of visits we offer and how they are billed. Even if your insurance plan covers your visit to CHOP, you may be responsible for cost-sharing expenses, such as co-pays, co-insurance and deductibles. We hope the information below is helpful.
What is included in a well visit?
A preventive visit — also called a well visit — is a scheduled check-up focused on keeping your child's whole body healthy and safe. These checkups are recommended for infants, children and teens. Kids need one preventive visit every year from age 3 through age 21; babies and young toddlers need them more frequently. These appointments can include preventive care like:
- A general physical exam – This includes measuring height, weight and blood pressure, and other age-specific growth and development checks.
- Age-specific immunizations (vaccinations) such as chicken-pox, measles, whooping cough, hepatitis, etc.
- Age-specific screenings, such as hearing and vision screenings.
These visits are typically covered by your health insurance, often at no cost to you. Some of the specific tools used during screenings may be billed separately.
What is a sick (office) visit?
This type of visit is made when your child is having a specific health problem, illness or injury, or for management of chronic, ongoing health problems and/or medications. Reasons for this type of visit can include:
- Illness such as the flu, strep throat or an ear infection
- Injury
- Anxiety/depression
- ADHD management
- Other chronic condition
There is usually a cost for this type of visit. Your insurance provider may pass some or all of the costs to you. You may be responsible for a copay, co-insurance or deductible.
Can I be charged for both types of visits?
Sometimes at a well visit, an issue comes up that's not part of the regular check-up but that needs to be addressed during that visit. Your provider could address a problem to manage a condition or illness and may prescribe medication, order additional tests like lab work or X-rays, or refer you to a specialist.
In these cases, insurance requires us to bill the visit as both a well visit and a sick (office) visit, so you will likely have to pay an additional co-pay or co-insurance, or the cost will be applied to your deductible.