HOW THE AFFORDABLE CARE ACT (ACA) AFFECTS WELLNESS CARE

As a result of healthcare reform, your medical insurance company is required to provide an annual wellness exam for policy holders. Wellness exams are defined as including a routine physical exam and some immunizations to patients at no additional copay, deductible or coinsurance. Because of this, insurance providers promote this as preventative care covered by insurance premiums without additional copay. These services (covered at no additional cost during the wellness visit) apply only to: immunizations; evaluation of growth; developmental screening tests; dietary and exercise lifestyle counseling.

COVERED

immunizations, evaluation of growth, developmental screening / tests, dietary and exercise lifestyle counseling

NOT COVERED

chronic conditions, reflux, allergies, fever, asthma, behavioral care, medication refills, ear pain, headache, cough, stomach pain, sore throat, etc.

Depending on your child’s age, gender, family history and other personal circumstances, we may advise more extensive blood tests, vision screen, hearing screen, x-rays or other appropriate tests. We want you to be aware that there is a possibility that some of these preventive tests or screenings may not be covered or fully paid by your insurance provider. Chronic conditions, reflux, allergies, fever, asthma, behavioral difficulties, medication refills, ear pain, headache, cough, stomach pain, sore throat typically require the patient pay a copay, deductible payment or coinsurance.

Evaluating and treating new or existing medical problems during this visit falls under “medical management” and is not a part of wellness care as defined by your health care insurance company and the Affordable Care Act. However, we understand that your time is valuable and we strive, when time permits, to address your medical concerns along with your wellness visit (essentially, two visits on the same day). Accordingly, an additional office visit or other service provided will require copay, coinsurance or any applicable deductible payment.

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