Family Resources

Has your insurance company processed your recent well visit and assigned “patient responsibility” to services that are typically covered as part of preventive care?

These include:

• Preventive/well-child visits and vaccines
• PHQ-9 (Depression Screening for ages 12+)
• PSC-17 (Pediatric Symptom Checklist for ages 4+) or similar developmental screenings
• SDOH (Social Determinants of Health screening)
• Vision screening
• Hearing screening

These services are standard components of preventive well visits. For patients with ACA-compliant insurance plans, they are generally covered at 100% with no copay, coinsurance, or deductible.

Why You May Still See a Charge

Although these services are part of routine preventive care, they must be billed separately using specific CPT codes, as required by federal billing and coding guidelines. Because of this, some insurance companies may incorrectly apply cost-sharing or patient responsibility to these services.

Under the Affordable Care Act, preventive screenings such as behavioral health screenings, vision, hearing, and social determinants of health screenings—when performed during a well-child visit—are considered preventive services and should be fully covered.

What You Can Do

We recommend contacting your insurance company to request a review or reprocessing of the claim. You may say:

• These services are part of routine preventive care covered under your plan.
• The provider correctly billed these services separately using required CPT codes.
• You are requesting the claim be reprocessed according to preventive care coverage guidelines.

If You Need to File a Complaint

If your insurance company does not resolve the issue, you may file a complaint with your state insurance department:

• Indiana Department of Insurance: www.in.gov/idoi (click “File a Consumer Complaint”)
• Illinois Department of Insurance: illinois.gov — File an Insurance Complaint

Refund Policy

If your insurance reprocesses the claim and issues payment, any amount previously collected from you will be promptly refunded.

If you need documentation to support your appeal, please contact our billing team at 219-322-8534.

Thank you for choosing Kids First Pediatrics on 30. We are committed to supporting your child’s health and helping you navigate insurance concerns as they arise.