Wellness and Problem Oriented Services

Wellness and Problem-oriented Services

The staff at Clinical Pediatric Associates of North Texas are committed to providing and maintaining the best possible care for our patients. Your review of billing practices in advance allows for good communication and common understanding.
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Insurance company billing policies dictate that we differentiate between two types of services.

Problem Oriented Services & Wellness Services

What is included in Wellness Services (also known as a preventive care visit or physical)?

Age appropriate history & medical exam

Anticipatory guidance (such as reducing fall risks for early walkers)

Preventive counseling (such as proper nutrition)

Review of vaccine history Review & interpretation of any recommended labs or age appropriate screenings

What other preventative related services will be billed separately?

Vaccine products

Vaccine administration services (including counseling)

Routinely recommended labs**

Screenings (e.g. vision, hearing, developmental screens)

The Affordable Care Act makes many wellness and/or preventative services covered in full by most insurance plans. However, this is not true of many problem-oriented services. Management of medical diagnoses, including the need for medication refills of any sort are categorized by insurance companies as problem-oriented services. Evaluation and/or management of any complaint and/or symptom offered by a patient or identified upon questioning during a preventive exam constitute a problem-oriented service.

Problem Oriented Services

Some common examples of problem-oriented services, screens or procedures include but are not limited to:

Illness addressed (ears, eyes, nose, throat, cough, fever, skin problems, etc.)

Suture Removal (if placed by another facility)

Chronic conditions addressed For example: Obesity, Asthma, Cholesterol, Lead, Hemoglobin Screening ADHD, Anxiety, Depression, Allergies

Mental Health questionnaires (For example PHQ9)

Travel concerns

Our medical practice wants to provide the most up to date, comprehensive care possible; circumstances arise where we must address a Problem Oriented Service during a Wellness Service. However, due to YOUR CONTRACT with YOUR INSURANCE COMPANY they may require a co-pay/deductible/co-insurance with the Problem Oriented Service. Additionally, we try to eliminate the need for the patient to return to the office, whenever possible. It is the responsibility of the policy holder to be aware of their insurance plan's coverage.
I acknowledge that during a wellness visit there may also be problem-oriented service(s) performed by the practitioner of Clinical Pediatric Associates of North Texas. It is understood that multiple charges may be submitted to my insurance company, and when applicable, a co-pay/deductible/co-insurance may occur as determined by my insurance policy. Alternatively, I understand I may choose to return for a separate visit to address problem-oriented issues, at which time, my co-pay/deductible/co-insurance will still apply.

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Wellness and Problem-oriented Services