We pride ourselves on providing only the highest quality care for your child and do this by following many of the American Academy of Pediatrics clinical guidelines and other trusted sources for evidenced-based clinical outcome information. However, insurers rarely keep pace with guidelines, or want to cover services related to meeting these clinical recommendations. In fact, insurance company rules and policies change all the time.
For example, your child’s hearing and vision screening may have been covered at your last visit, but that is no guarantee that your insurer will cover the same screening at this visit. Frustrating, isn’t it? And often we only find out that a plan is no longer paying for something when they send us a payment denial for a bill.
So why do these policies change anyway? Well, your insurer is constantly looking to improve their profits, and making changes such as what to pay for and what to deny really helps their bottom line, quarter-to-quarter. It’s unfortunate for both of us, as we waste time and effort having to find out why payment was denied and then have the expense of billing you for it, while you, in addition to your copay / coinsurance / deductible cost sharing, may now have a ‘non-covered service’ to pay for too.
Your insurer may already have a policy in place whereby it does not cover things like in-office strep testing and urinalysis, to name a few. You can verify with your insurer which services it covers and which it does not. Performing tests in-office is faster and more efficient than sending tests out to labs, and performing screenings such as hearing and vision tests avoids incurring the inconvenience and expense on your part to refer you to a specialist for these things.
As prompt and appropriate treatment of your child is of primary importance to us, we ask that you sign a ‘waiver’ (at the back of this guide) giving us permission to perform screenings and tests as we, your trusted providers of care, deem necessary.
Following is a list of the most frequently provided services for which we request a signed waiver and that you can use to determine coverage with your insurer.
This is an important hearing test and can be used on newborns through adulthood. It does not require a soundproof room or the ability of the child to understand instructions or respond to sounds, which makes it a much more accurate screening tool for picking up on hearing issues at any age. Not only do we believe that hearing screens should be performed every year, but testing is required for most preschools, public and private schools, and for sports. Many insurance companies cover these screenings, however, at the time of publication of this guide, Oxford Health Plans will only cover the screening for a child aged 3 years and younger.
As we consider this to be an important test for your child, and will routinely perform it at annual well visits, if your insurer does not cover the charge, we will significantly discount the amount to $15.00 per test.
Audiogram. This is a hearing test for verbal children. If your insurer does not cover the charge, you wll be billed the discounted price of $10.00.
Often, patients want to know as soon as possible if their child has the flu, strep, mono etc. We can effectively and efficiently determine that by performing in-office testing. Many insurers do not pay for in-office testing because they have contracts with external labs to provide these services. However, sending tests out to external labs results in waiting days for results that we can provide to you much more quickly (in some cases, within minutes or overnight). We believe it is important to treat your child as quickly as possible, and therefore offer these services in-office.
The following in-office labs (and possibly others) may incur additional fees:
- Rapid Strep
- Rapid Flu
- Rapid COVID
- Rapid RSV
- Urine Culture
- Throat Culture
- Mono Spot
- Hemoglobin testing
- Lead testing
If you do not wish for your child to have any of these tests or screening exams, please inform the staff at the beginning of your visit. Please realize that in doing so it may be necessary to send a test to an outside lab, refer you to a drawing station, or schedule a visit with a specialist in order to obtain the necessary information. This may significantly delay diagnosis and treatment, return to school or activities, or the provision of requested forms.
Developmental screening (including standard pediatric developmental screening done at well-visits, Connors forms, Edinburgh post-partum depression screening, etc) are very important in the assessment of any development delays or potential problems.
As we consider these to be important tests for your child, and will routinely perform them at annual well visits, if your insurer does not cover the charge, we will significantly discount the amount to $10.00 per test.
This is a simple screening performed with the use of a Snellen eye chart used to measure visual acuity on older children. Visual Evoked Potential testing (or VEP). This is an important test for early detection of eye and vision problems in infants and young children. Amblyopia (or ‘lazy eye’) occurs when the brain does not receive proper images from the eye. If it is not diagnosed in early childhood, there may be a permanent loss of vision in the affected eye. We perform this test yearly in the first 6 years of life. Unfortunately, some insurers do not cover this test at this time.
As we consider these to be important tests for your child, and will routinely perform them at annual well visits, if your insurer does not cover the charge, we will significantly discount the amount.
For Snellen tests the discounted price is $10.00, and for VEP tests the discounted price is $30.00.