Anderson Hills Pediatrics is proud to be a locally owned and operated pediatric practice, striving to provide you with the highest level of care and service that is both personalized and affordable. Here is a list of our most frequently asked billing questions.
I received an additional charge for a check-up appointment. My insurance fully covers check-ups. Why am I being billed?
Sometimes, a child needs a service that is not considered preventative on the same day as a well-child visit. In other words, if there is a medical concern that would have normally prompted a separate appointment, it can be added to the check-up visit rather than requiring you to schedule a separate visit. By adding the appointment to a well care visit, our patients save both time and money (as the cost of this type of visit is lower).
Examples of services that may be billed in addition to preventative services include:
- ADHD or asthma follow-up with medication management
- Work-up for fever or illness at the time of the check-up
- Any procedure such as wart treatment, foreign body removal
- Mental health concerns that require extra time to discuss
My bill for a check-up included several screeners that were billed separately from the visit. Why is that not included in the visit, and why am I getting a separate charge for these?
The screeners billed separately from your check-up serve to provide a more thorough evaluation of your child’s health as recommended by the American Academy of Pediatrics. Some insurance companies require that we bill for all screeners completed during your child’s visit as separate charges, while others bundle them into the visit charge.
My bill for a COVID, RSV, Strep, or Flu test seems high. Why is that?
Anderson Hills Pediatrics is proud to offer in-office molecular testing for flu, strep, COVID-19, and RSV. Apart from its superior accuracy and comprehensive detection capabilities, molecular testing also offers timely results and is considered the gold standard in pediatric medicine. When other providers offer cheaper testing, it is because they utilize antigen testing instead of molecular testing. An example of an antigen test is the over-the-counter COVID test.
Anderson Hills believes in matching the tests we offer to the highest standard of care to ensure your child receives the correct treatment. This is also the type of testing that Cincinnati Children’s uses. For many patients, these tests are relatively inexpensive. Still, the cost can vary significantly depending on the contractual rate of your specific insurance plan.
If you have any concerns or preferences regarding testing during illness visits, feel free to discuss them with your child’s pediatrician.
I took my child to urgent care for illness, and the visit cost appeared cheaper. Why is that?
While it may seem cheaper to seek treatment at an urgent care center, it’s important to consider the differences in the standard of care provided. Urgent care centers often utilize antigen testing, the over-the-counter type of tests as mentioned above, which tends to be less expensive compared to other molecular testing. Additionally, they commonly employ advanced practice providers (APPs), such as nurse practitioners or physician assistants, who can provide care at a lower cost than physicians.
Additionally, we prioritize comprehensive care that includes a thorough understanding of your medical history. Our detailed pediatric knowledge allows us to tailor treatment plans specifically to your child’s needs, ensuring better medical decision-making. This emphasis on personalized care and utilizing a full patient history results in a higher level of care and, ultimately, better outcomes for our patients.
My child was billed for a “detailed” visit, but they were with the physician for 15 minutes. Is this correct?
Billing for medical services involves more than the duration of the face-to-face visit. It also considers factors such as the complexity of care provided, documentation requirements, risk of treatment, and time spent on a patient’s care outside of the visit itself. Even if face-to-face time seems brief, assessments, medication management, care coordination, follow-up on labs or imaging, and counseling contribute to the overall billing level.
How can I know beforehand how much I can expect to pay for care?
Since the cost of care varies significantly by individual insurance plan, it is important to speak with your insurance carrier about your allowed amounts for visits.
These are common medical codes used:
- Most used Office Visits Codes – These codes are generally used during illness, medication, and follow-up appointments. These codes may also be billed if an additional concern is discussed at an annual check-up.
- 99213 (Expanded)
- 99214 (Detailed)
- 99215 (Comprehensive)
- Flu Test – 87502
- COVID Test – 87635
- Strep Test – 87651
- RSV Test – 87807
Who Should I Call with Questions?
If you have any questions regarding billing or coding for services, please don’t hesitate to contact our billing team at (513) 232-8100 option 5.
As always, it is a privilege to provide care for the children of this community. We sincerely appreciate your trust and loyalty over the years.