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How Much Does A Pediatrician Visit Cost Without Insurance

Published: November 23, 2023

Without insurance, the cost of a pediatrician visit can vary. Learn about the different factors that can impact the price and find ways to manage your finances effectively.

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Table of Contents

Introduction, understanding pediatrician visits, factors affecting the cost of pediatrician visits, average cost of pediatrician visits without insurance, ways to reduce the cost of pediatrician visits without insurance, free and low-cost options for pediatrician visits.

When it comes to taking care of our children’s health, regular visits to a pediatrician are crucial. However, not everyone has the luxury of health insurance coverage to offset the costs associated with these visits. That’s why it’s essential to understand how much a pediatrician visit may cost without insurance.

A pediatrician is a specialized doctor who provides medical care for infants, children, and adolescents. These visits involve routine check-ups, immunizations, developmental assessments, and addressing any concerns parents may have about their child’s health. While the primary focus is on the well-being of the child, the financial aspect cannot be overlooked.

The cost of a pediatrician visit without insurance can vary significantly depending on various factors such as the location, services provided, and the specific needs of the patient. Understanding these factors can help parents better navigate the financial aspect of pediatrician visits and plan accordingly.

In this article, we will delve into the factors that influence the cost of pediatrician visits without insurance, explore the average costs, and discuss ways to reduce the financial burden. We will also touch on free and low-cost options available for families facing financial constraints.

It’s important to note that while this article provides general information, the actual costs can vary, and it is always advisable to consult with a pediatrician or healthcare provider for accurate and up-to-date information.

Now, let’s dive deeper into the world of pediatrician visits and understand how much they may cost without insurance coverage.

Pediatrician visits are an essential aspect of a child’s healthcare journey. These visits serve several purposes, including preventive care, assessing growth and development, addressing health concerns, and providing necessary vaccinations. By understanding the different aspects of pediatrician visits, parents can ensure their child receives comprehensive healthcare.

Preventive care is a key component of pediatrician visits. Regular check-ups, often referred to as well-child visits, are scheduled at various intervals, starting from infancy and continuing through adolescence. These visits allow the pediatrician to monitor the child’s growth and development, assess their overall health status, conduct routine screenings, and provide guidance on nutrition, safety, and age-appropriate activities.

During pediatrician visits, developmental assessments are conducted to track the child’s milestones, such as cognitive, motor, and social-emotional development. This enables the pediatrician to identify any potential delays or concerns and provide appropriate interventions or referrals to specialists if necessary.

Immunizations are another important aspect of pediatrician visits. These vaccinations protect children against various diseases and help maintain community immunity. The pediatrician will administer vaccines according to the recommended schedule, ensuring that the child is up to date with the necessary immunizations.

In addition to preventive care, pediatrician visits address any health concerns or issues that parents may have about their child’s physical or emotional well-being. This can include acute illnesses, chronic conditions, allergies, behavioral concerns, or any other medical issues that may arise. The pediatrician will conduct examinations, order tests if needed, and provide appropriate treatment or referrals to specialists.

Overall, pediatrician visits play a vital role in promoting and maintaining children’s health and well-being. By establishing a strong relationship with a pediatrician, parents can ensure that their child receives comprehensive medical care, guidance, and support throughout their development.

In the next section, we will explore the factors that can influence the cost of pediatrician visits without insurance.

The cost of pediatrician visits without insurance can vary depending on several factors. Understanding these factors can help parents anticipate and plan for the expenses associated with their child’s medical care. Here are some key factors that can influence the cost of pediatrician visits:

• Location: The geographical location plays a significant role in determining the cost of pediatrician visits. In areas with a higher cost of living, such as major cities, the fees may be higher compared to smaller towns or rural areas. It’s important to research and compare the rates of pediatricians in your specific location to get an idea of the expected costs.
• Type of Visit: The purpose of the visit can also affect the cost. Routine well-child visits, which include preventive care and developmental assessments, may have a different price range compared to visits for acute illnesses or specialized consultations. The complexity and duration of the visit can impact the overall cost.
• Services Provided: Pediatrician visits may encompass a range of services, from physical examinations and vaccinations to laboratory tests and screenings. The cost may differ depending on the specific services provided during the visit. For example, additional tests or procedures may incur extra charges.
• Additional Services: In some cases, pediatricians may offer additional services or procedures not covered by insurance, such as certain types of counseling or specialized treatments. These services may come at an additional cost, so it’s important to discuss and understand what is included in the visit and any potential extra charges.
• Experience and Reputation: Pediatricians with extensive experience and a strong reputation in their field may charge higher fees for their services. The level of expertise and recognition can impact the cost of pediatrician visits. However, it’s essential to consider the quality of care and the relationship with the pediatrician when evaluating the value of their services.

It’s important to note that these factors are not exhaustive, and the cost of pediatrician visits can vary from practice to practice. The best way to determine the specific cost of pediatrician visits without insurance is to contact the pediatrician’s office directly and inquire about their fees and any additional expenses that may be incurred.

Now that we understand the factors influencing the cost of pediatrician visits, let’s explore the average costs parents can expect to encounter without insurance coverage in the next section.

While the cost of pediatrician visits without insurance can vary, it’s helpful to have a general understanding of the average expenses you may encounter. Keep in mind that these numbers are approximate and can differ based on the factors discussed earlier.

A routine well-child visit, which includes a comprehensive examination, developmental assessment, and immunizations, can cost anywhere from $100 to $300 without insurance. The cost may be higher for initial visits or visits that involve additional screenings or specialized consultations.

Visits for acute illnesses or specific concerns may have different price ranges. For example, a visit to address a common illness like the flu or a minor injury may range from $75 to $150 without insurance. However, if the visit requires additional tests or treatments, the cost can increase accordingly.

It’s important to note that these costs are for the pediatrician’s services only and do not include any additional costs such as laboratory tests, X-rays, or medications. These additional expenses can further contribute to the overall cost of the visit.

It’s worth mentioning that some pediatricians offer discounted rates or payment plans for uninsured patients, so it’s helpful to inquire about any available options when scheduling an appointment. Additionally, some practices may have a sliding fee scale based on income for families who meet specific criteria.

Now that we have a general idea of the average costs, let’s explore some strategies to help reduce the financial burden of pediatrician visits without insurance in the next section.

While the cost of pediatrician visits without insurance can be a financial burden, there are several strategies that parents can employ to help reduce these expenses. Here are some ways to mitigate the costs and make pediatrician visits more affordable:

• Shop around: Research and compare the rates of different pediatricians in your area. Look for practices that offer competitive pricing without compromising the quality of care. Additionally, inquire about any discounts or payment plans that may be available for uninsured patients.
• Consider telemedicine: Telemedicine services have gained popularity in recent years, allowing remote consultations with healthcare providers. Some pediatricians offer virtual visits, which can be a more cost-effective option compared to in-person visits. This can be particularly useful for minor illnesses or follow-up consultations.
• Utilize community health clinics: Community health clinics often provide low-cost or free pediatric services to families in need. These clinics may offer comprehensive well-child visits, vaccinations, and basic medical care at reduced rates. Research local community clinics in your area and determine if you qualify for their services.
• Explore government assistance programs: Depending on your income level and eligibility criteria, you may qualify for government assistance programs that provide healthcare coverage for children. Programs such as Medicaid or the Children’s Health Insurance Program (CHIP) can help offset the costs of pediatrician visits and other medical expenses. Check if you meet the requirements to enroll in these programs.
• Ask for itemized billing: When receiving the bill for a pediatrician visit, ask for an itemized breakdown of the charges. This will help you understand the specific services provided and allow you to identify any potential errors or unnecessary charges that can be addressed.
• Negotiate payment plans: If you are facing financial limitations, communicate with your pediatrician’s office and explore the option of setting up a payment plan. Many healthcare providers are willing to work with patients to establish affordable payment arrangements over time.
• Consider healthcare savings accounts: Healthcare savings accounts, such as Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), allow you to set aside pre-tax money specifically for medical expenses. By utilizing these accounts, you can allocate funds for pediatrician visits and reduce the financial burden.

It’s important to proactively communicate with your pediatrician and be open about your financial situation. They may have additional resources or recommendations to help you navigate the cost of pediatrician visits.

Now, let’s explore some free and low-cost options available for families facing financial constraints.

Families facing financial constraints can still access pediatrician visits through various free and low-cost options. These resources ensure that children receive the necessary medical care regardless of their financial situation. Here are some options to consider:

• Community health clinics: As mentioned earlier, community health clinics often provide pediatric services at reduced rates or even for free. These clinics prioritize serving low-income individuals and families and offer comprehensive healthcare, including well-child visits, vaccinations, and basic medical care. Contact local clinics or use online directories to find community health centers in your area.
• School-based health centers: Many schools have health centers on their premises that offer medical services to students. These centers often have pediatricians or nurse practitioners available to provide healthcare, including routine check-ups and evaluations. If your child attends a school with a health center, it can be a convenient and affordable option for pediatrician visits.
• Government assistance programs: Government programs, such as Medicaid or the Children’s Health Insurance Program (CHIP), provide healthcare coverage for eligible children from low-income families. These programs offer comprehensive medical services, including pediatrician visits, at little to no cost. Check if you meet the criteria to enroll your child in these programs and access the benefits they provide.
• Non-profit organizations: Some non-profit organizations and charities focus on improving access to healthcare for children in need. They may offer free or low-cost pediatrician visits or collaborate with healthcare providers to provide subsidized services. Research local non-profit organizations that focus on children’s healthcare and inquire about their available resources.
• Teaching hospitals and medical schools: Teaching hospitals and medical schools often provide pediatric services at reduced rates. These institutions train medical students, residents, and fellows, who can offer care under the supervision of experienced physicians. While the cost is typically lower in these settings, the quality of care remains high. Contact teaching hospitals or medical schools in your area to inquire about their pediatric services.
• Wellness programs and health fairs: Many communities organize wellness programs and health fairs that include free or low-cost healthcare services, including pediatrician visits. These events often collaborate with healthcare providers to offer medical check-ups, vaccinations, and health education. Stay informed about such programs in your community and take advantage of the available services.

Remember to research and reach out to these resources in advance to determine their availability, eligibility criteria, and any necessary documentation you may need to bring with you. These options can help ensure that your child receives the medical care they need without placing a significant financial burden on your family.

Now, let’s conclude our discussion on the cost of pediatrician visits without insurance.

Regular pediatrician visits are essential for the health and well-being of children, but the cost can be a concern for families without insurance coverage. Understanding the factors that influence the cost of pediatrician visits, such as location, type of visit, and services provided, can help parents anticipate expenses and plan accordingly.

The average cost of pediatrician visits without insurance can range from $100 to $300 for routine well-child visits, while visits for acute illnesses or specialized consultations may have different price ranges. It’s important to keep in mind that additional costs for laboratory tests, medications, and procedures can further contribute to the overall expenses.

There are several ways to reduce the cost of pediatrician visits without insurance. Shopping around, considering telemedicine, utilizing community health clinics, exploring government assistance programs, and negotiating payment plans are all strategies that can help alleviate the financial burden. Additionally, healthcare savings accounts can provide a means to set aside funds specifically for medical expenses.

For families facing financial constraints, free and low-cost options are available to access pediatrician visits. Community health clinics, school-based health centers, government assistance programs, non-profit organizations, teaching hospitals, and wellness programs can provide pediatric services at reduced rates or even for free.

While this article provides general information, it’s important to consult with a pediatrician or healthcare provider to get accurate and up-to-date cost details for pediatrician visits without insurance. They can provide personalized information based on your specific situation.

Remember, the well-being of your child should be a top priority, and there are resources available to ensure they receive the necessary medical care, even without insurance coverage. By taking proactive steps to manage the costs, you can provide your child with the healthcare they need while minimizing the financial impact on your family.

Now that you have a better understanding of the cost considerations and available options, you can approach pediatrician visits with confidence, knowing that there are ways to make it more manageable for your family.

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• https://livewell.com/finance/how-much-does-a-pediatrician-visit-cost-without-insurance/

• Without health insurance, a full year of the recommended seven well baby visits costs an average of $668 total -- or just over $95 per visit -- according to the American Academy of Pediatrics.
• Immunizations for the first year cost at least $620 extra and usually are covered by health insurance.
• Well baby visits are almost always covered by group health insurance -- in 97 percent of cases with PPOs and 99 percent of cases with HMOs -- according to a survey by the Kaiser Family Foundation[ 2 ] . However, some insurance policies require that the baby be added to the insurance plan within a certain time frame -- usually by one month after birth, so check with your provider.
• For patients covered by insurance, out-of-pocket costs, usually copays, typically range from $10 to $30 per visit, depending on the plan.
• During the first well baby visit, the doctor will weigh and measure the baby to check growth; check eyesight and hearing; check for common problems such as diaper rash or the flaky scalp known as "cradle cap"; and look at umbilical cord stump or wound and, if necessary, administer a hepatitis shot. Subsequent visits will include immunizations, measurement of the head to check brain growth, addressing concerns about child safety and common health issues such as colds, croup, ear infections and diarrhea.
• At well baby visits, the doctor usually will ask about the baby's sleeping, eating and bowel habits and development markers, such as whether the baby can hold its head up or quiets at the sound of the parent's voice. The answers allow the doctor to make sure the baby's development is progressing on schedule.
• BabyCenter.com[ 3 ] has detailed lists of what to expect at each well baby visit.
• It is not uncommon for a baby to become ill in the first year of life, so additional doctor visits might be necessary.
• The U.S. Department of Health & Human Services[ 4 ] offers information on low-cost or free health insurance for uninsured children in qualifying families. This insurance can be used for well baby visits.
• Most parents choose a doctor who is a pediatrician, which means they have graduated from medical school and had an additional three years' residency in pediatrics. It is recommended to find a pediatrician before the baby is born.
• To find a pediatrician, ask a friend or family member for a referral. Or, the American Academy of Pediatrics offers a pediatrician locator service by state.
• When you find a prospective pediatrician, check credentials to make sure the doctor is board-certified by the American Board of Pediatrics or the American Board of Family Medicine[ 5 ] .
• It also is a good idea to meet your prospective pediatrician face-to-face. Observe the waiting room and ask questions about background, areas of interest, how the doctor can be reached after-hours in an emergency, how many doctors are in the office, whether the child will be able to see the same doctor for well and sick visits and how long a typical appointment lasts. WebMD.com[ 6 ] offers a guide to selecting a pediatrician.
•   www.nlm.nih.gov/medlineplus/ency/article/001928.htm
•   kff.org/medicaid/report/struggling-with-financing-the-recession-and-national-healt...
•   www.babycenter.com/0_doctor-visits-for-your-babys-first-year_66.bc
•   www.insurekidsnow.gov/
•   /www.theabfm.org
•   www.webmd.com/baby/shopping-for-a-pediatrician

How Much Does a Well-Baby Doctor Visit Cost?

In order to ensure that your baby is growing properly, it is recommended that you schedule well-baby doctors visits on a regular basis.  In the first year, a baby should see the doctor for 7 well-visits: between 2-5 days after birth, and then at one, two, four, six, nine, and twelve months.  During the second year, the baby will usually visit every three months.

How much does a well-baby delivery visit cost?

Without insurance, the cost of a well-baby doctor’s visit is right around $100.  However, the majority of these visits are covered by insurance and the only thing you will need to pay is your copay, which could range from $5-$25 depending on your insurance provider.   A baby will need a visit during the first week of life, followed by a two-week visit, four-month visit, six-month visit, nine-month visit, and first-year visit.

Without insurance, the cost of immunizations for your baby’s first year will be, on average, a little over $600.  This won’t include the physician fee.  This cost is almost always covered by insurance, however, and some states even do it for free for those without insurance.

According to BMO Harris Bank, the average out-of-pocket medical expenses in the first year is about $1,297 .

Well-baby delivery visit overview

As noted on the charts above, well-baby visits will be done during the first week, first month, second month, fourth month, sixth month and ninth month.

Mayo clinic provides much information regarding what to expect at each of the child’s well-baby check-ups in the first year.

The doctor will take the baby’s measurements including his or her height, weight, and head circumference.  A doctor will use a chart to see how your child is growing compared to other children in the same range.

Your baby’s head will be checked for soft spots as well as external problems such as cradle cap.

The doctor will look in the baby’s ears, mouth, and eyes.

A stethoscope will be used to listen to the baby’s heart and lungs.

The doctor will press and feel the baby’s abdomen to make sure there are no problems with the organs.

The doctor will move the baby’s hips and legs around to see if there are any dislocations or bone problems.

The baby’s genitalia will be checked for a number of different things, such as a hernia.

Immunizations will also be given according to schedule.

During these visits, a pediatrician will ask if the baby is hitting milestones, is active and is eating well.

What are the extra costs?

Some doctor offices charge a “new patient” or “processing” fee for the first visit.

The visits discussed here are only well-baby visits.  If your child becomes ill, the cost will increase.

Tips to know:

When choosing a pediatrician, be sure to ask friends and family for a recommendation.  While the Yellow Pages can help with the search, you’re not going to be able to get a first-hand experience.  Neighbors, friends and family will be more than happy to assist those with recommending a good pediatrician.

Do a background check with your pediatrician to see if any wrongdoings have been done in the past.  The Federation of State Medical Boards (FSMB) can show you if there are serious disciplinary actions, or if there are any bad marks.

It doesn’t hurt to interview a handful of those that you’re interested in.  Before talking with one, make sure that your insurance company works with this doctor.

Take a look around the office.  How clean is the office?  Talk with the staff.  How is the staff?  Are they accommodating?  Do they feel annoyed when you ask them questions during off hour sessions?  Does the pediatrician make you feel stupid when you ask questions?  It’s always best to trust your gut.

Be sure to add your newborn to your health insurance policy within 30 days.

According to the Affordable Care Act, the health care reform law notes that well-baby visits must be covered.

Questions to ask:

How many doctor’s offices do you have?  If there is more than one, ask them why they have more than one.

What are the latest trends with diseases, nutrition and treatments?  What are you doing to help prevent these problems?

What is your experience with working with children?  How long have you been practicing medicine?

Do you have any references that I can talk to?

Is my baby up to date with immunizations?

What can I do to make sure my baby is sleeping healthy?

How much television can my baby watch?

How can I compare prices?

Most people find a doctor based on a friend or family member’s recommendation.

Some insurance companies have a list of recommended doctors from which to choose.

Websites such as pediatricians.com can help you find a pediatrician in your area.  Be hesitant when reading reviews online.  These reviews can commonly be rigged by insiders.

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Average Reported Cost: $122

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Well Child visit was $122 with no ins.

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How Much Does a Well Baby Doctor Visit Cost?

Welcoming a new baby is an exciting, rewarding experience. As a parent, you want to do everything possible to safeguard your child’s health and well-being in their critical early years.

Well-baby visits with a pediatrician play an integral role in monitoring your baby’s development, catching potential issues early, and providing needed immunizations. However, these services come at a cost that must be planned for.

With some diligence and planning ahead, you can secure quality affordable medical care for your baby’s first year and beyond. Monitoring your child’s health is a top priority, but finding cost-effective solutions provides peace of mind. Let’s take a deeper look at how to make well-baby visits work within your family’s financial means.

Unlike a standard co-pay, fees for well-baby exams can vary significantly based on your specific circumstances. Gaining clarity on cost drivers allows more accurate budgeting.

According to the Kaiser Family Foundation 2022 survey, routine well-child visits cost between $20 and $600 per exam . Here’s what to expect:

• Uninsured –  $300 to $600 per exam  on average
• Insured, without meeting deductible –  $100 to $300 per visit
• Insured, after meeting deductible –  $20 to $50 copay per visit

Your total first year well exam expenses could range anywhere from $700 to $3,000+ . Geography, your insurer, and specific pediatric office fees will determine your actual rates.

According to Care Better, the average cost of a pediatrician visit for uninsured patients ranges from $100 to $250 for new patient visits, with recurring visits possibly slightly lower. Well-baby visits typically cost between $100 to $150 , varying by state.

Be aware that additional costs beyond the exam itself may apply, including fees for screenings, lab work, specialist referrals or consultations, out-of-network charges, prescription medications, medical equipment, and more during visits. Immunization costs must also be accounted for separately.

The Many Factors Impacting the Price of Well-Baby Visits

The exact cost per visit depends on several key factors:

• Insurance  – Copays, deductibles, coinsurance percentages, in-network discounts, and covered services all affect out-of-pocket fees.
• Pediatrician or clinic  – Providers determine their own charges for exams and services based on overhead, administrative costs, and other business factors.
• Geographic location  – Healthcare costs vary greatly by region, state, and even within the same city.
• Services rendered – The number and types of screenings, tests, injections, lab work, and specialized assessments conducted during the visit impact costs.
• Visit frequency  – More wellness exams mean higher overall annual prices for care.
• Incidentals  – Other one-off charges for medical forms, prescription medications, equipment rentals, etc may arise.

Why the Range in Prices is so Extreme

There are clear reasons why average well-baby checkup costs have such an incredibly wide range nationally.

At the lower end are insured families with excellent in-network coverage who’ve met their deductible for the year. Their out-of-pocket cost per visit may simply be a minimal copay of $20-50 . Total first-year expenses could be as little as $700 or so .

Meanwhile, uninsured families paying 100% out-of-pocket can expect to spend $300 or more per exam, even with some discounting. Their annual costs could approach $3,000+ in the baby’s first year.

Those with insurance but unmet deductibles land in the middle, potentially owing $100-$300 per visit until reaching their deductible threshold. Their yearly total would likely fall between $1,000-$2,000 .

Geography also plays a major role in cost variance. Average prices in urban areas and on the coasts tend to be higher than in rural regions and the Midwest. Competitive insurance markets and Medicaid-managed care can reduce prices in some states as well.

Out-of-Pocket Costs Can Exceed Reimbursed Rates

One surprising aspect of well-baby visit costs is that insured patients may sometimes pay more per visit out-of-pocket than the actual billed charge prior to insurance adjustments.

For example, your pediatrician may bill $150 for a routine exam, which is discounted to $125 by your insurer. But if your plan has a high unmet deductible and 30% coinsurance, you may owe the full $150 at that visit.

This occurs because insured rates account for contracted discounts which don’t apply to patient responsibility until the deductible is satisfied. Be sure to clarify out-of-pocket costs with your provider’s billing department.

Schedule of Well-Baby Visits in the First Year

To budget and plan for your baby’s routine medical care, it helps to understand the standard schedule of recommended wellness exams in the first year along with typical fees charged.

Importance of Following the Well-Baby Visit Schedule

The American Academy of Pediatrics (AAP) delineates a well-baby visit schedule based on age to ensure proper monitoring of growth milestones and administering vaccinations. Following this routine allows your pediatrician to screen hearing, vision, development, and other health factors at important times.

Catching any potential issues early through these well-checks provides the opportunity for early intervention, treatment, and parent education for the best outcomes. Don’t skip recommended visits due to cost concerns without discussing other options with your provider first.

The Standard Well-Baby Check-Up Schedule

• Newborn: Initial hospital visit or within 3-5 days after discharge
• 12 months – Includes first-year vaccinations & developmental screening
• 24 months – Includes age 2 vaccinations & autism screening

Annual visits continue ages 3-6. Additional sick visits occur as needed.

Estimating the Costs Associated with Routine Well-Baby Visits

Using the average cost ranges discussed earlier, we can estimate typical fees associated with each recommended well visit:

• The exam portion will likely cost  $100 – $300 per visit  based on insurance
• Required vaccinations may add $100 – $350 per visit
• Additional screening tests  like lab work, hearing tests, etc may each cost  $50 – $200

Conservatively, you’ll spend around $1,500 – $2,500 in the first year for well-baby exams and immunizations. Be prepared for higher costs if you have testing, see specialists, need prescriptions, or lack insurance.

Understanding these expected expenses allows you to budget and financially prepare for this essential care.

Insurance Coverage Can Vary Widely

Navigating health insurance for your newborn is crucial yet confusing. Plan specifics dramatically impact your out-of-pocket costs. Let’s demystify this process.

Securing Coverage for Your Baby

If your baby won’t be covered under your existing plan, purchase a marketplace policy or employer-based coverage by their birth to avoid gaps. Shop insurers and policies carefully, assessing premiums, provider networks, deductibles, copays, coinsurance, out-of-pocket maximums, and covered services.

You can also read our articles about the cost of baby formula , daycare , and the cost of having a baby .

Having no lapse in coverage protects your child and reduces newborn care costs. Read your insurance materials thoroughly or call member services with questions.

The Ins and Outs of Health Insurance Terminology

Here are some health insurance terms and how they relate to your costs:

• Premium – The upfront monthly or yearly amount you pay for coverage.
• Deductible – The amount owed for care before insurance coverage kicks in, often $1000-$5000. You pay 100% until met.
• Copay – A fixed dollar amount per visit after deductible, typically $20-$50 for primary care.
• Coinsurance – The percentage you pay after deductible, such as 20%.
• Out-of-pocket max – The most you’ll spend for essential covered care annually, generally $3000-$6000.
• Allowed amount – The fee agreed upon by your insurer and provider for a service. This is the basis for determining your responsibility.
• In-network providers – Doctors within your plan’s network who offer better rates. Go in-network when possible.
• Preauthorization -approval required by your insurer before certain services. Check to avoid surprise bills.
• Covered services – Specific well-baby visit elements, tests, specialists, etc included in your policy. Review closely.

Questions to Ask About Your Health Insurance Coverage

• Is my pediatrician/clinic in-network? Are labs and specialists they use in-network?
• What is my deductible and has it been met yet?
• What are my copays for sick visits vs. well visits?
• What coinsurance percentage applies?
• What’s my out-of-pocket maximum?
• Does my policy cover well-baby check-ups and which specific services?
• Are there service limits? Preauthorization requirements?
• Can I be charged for fees outside the allowed amount?
• What vaccinations are covered? What do they cost?

Once armed with this information, you can accurately estimate your potential out-of-pocket responsibility.

Budgeting Strategies

With copays, coinsurance, unexpected medical fees, and other new baby expenses, healthcare costs can quickly strain the family budget. Proactively planning ahead is key to weathering this financial challenge.

Look Beyond Just the Cost Per Visit

The fees for well-baby appointments are just one portion of your child’s overall medical expenses that first year. You’ll also need to budget for:

• Health insurance premiums
• Hospital bills for delivery and newborn care
• Prescriptions, medical equipment/supplies, and over-the-counter medicines
• Urgent care or ER visits for illnesses
• Dental and eye care
• Travel costs related to care

Don’t overlook these additional items when doing your healthcare budget. Their unexpected timing can also wreak havoc on finances if unprepared.

Tips to Financially Prepare

With smart planning, you can limit stress when those pediatric bills start rolling in:

• Call your insurer and doctor to learn prices and your responsibility
• Ask about bundled pricing or package deals for bundled well visits upfront
• Calculate your deductible and plan to meet it
• Establish an emergency fund for medical surprises
• Open a flexible spending account to pay bills tax-free

Check if you qualify for WIC, Medicaid, or other assistance programs if uninsured. Understanding costs allows you to be proactive and stay in control.

When Budgeting, Plan for More Visits

While only 6-8 well-baby visits are guideline-recommended the first year, budgeting for additional sick visits just in case is wise. Babies commonly have:

• 8-10 colds annually
• 6-8 ear infections before age 1
• 3-9 bouts of diarrhea per year
• Viruses causing fevers

Your budget should account for at least 2-4 extra unplanned pediatric appointments to treat routine illnesses in year one. Check with your insurer about your urgent care vs ER visit costs too. Staying financially prepared provides peace of mind if your baby does get sick.

Seeking Out Affordable Well-Baby Care

Despite diligent planning, some families still struggle to manage healthcare costs amidst limited incomes and other financial challenges. Many public and private resources exist to provide pediatric care assistance in these situations.

Government-Sponsored Healthcare for Children

Medicaid, SCHIP, and Tricare are government-sponsored health programs providing free or subsidized medical care for children in households under certain income limits. Coverage includes well-child visits along with hospitalizations, prescriptions, hearing and vision services, dental care, medical equipment and more at little to no cost based on state eligibility rules. These programs are invaluable for lower-income families.

Non-Profits and Community Health Centers

Various organizations assist families struggling to afford pediatric expenses. Charities like Ronald McDonald house provide housing when kids need extended hospital care. Local non-profits and community health centers may supply vouchers or grants to cover well-baby visits for uninsured or underinsured households.

Do research to identify groups offering pediatric health assistance in your region. Your OB, hospital social worker or health department can also refer possible resources. Don’t be afraid to ask for help – your baby’s health comes first.

How Hospital Charity Care Helps

Most hospitals provide charity care – free or discounted services – for uninsured and underinsured patients, including families with newborns.

If household income falls below 200-400% of the Federal Poverty Level, you may qualify for partially or fully reduced pediatric healthcare fees, including well-baby visits.

Check with hospital billing departments for information on potential savings through charity care programs. But apply promptly before outstanding balances go to collections, negatively impacting your eligibility.

Partnering with Your Pediatrician

Don’t be afraid to have an open conversation with your children’s doctor about cost concerns and payment options. Most pediatricians aim to ensure all patients receive needed care regardless of financial challenges.

Many allow establishing installment payment plans for families, waive or discount visit fees, connect patients with community resources, identify affordable prescription options, and go above and beyond to help during difficult times.

Communicating about monetary challenges allows your pediatrician to assist as an advocate. Medical providers want to see kids thrive.

Next Steps to Affordable Well-Baby Care

Providing your new baby with the best possible medical care during the vital first year of rapid growth and development is any parent’s top priority. But the costs associated with well-visits, screenings, vaccinations, and more can certainly be daunting. Hopefully, this guide has shed light on smarter budgeting for this essential pediatric care through:

• Learning the average costs and cost drivers for well-baby visits
• Understanding your health insurance and out-of-pocket responsibility
• Budgeting for deductibles, copays, coinsurance, unplanned visits and expenses
• Following the recommended visit schedule for your child
• Identifying ways to save on costs proactively
• Researching financial assistance resources for affordable care options

As you embark on this exciting parenting journey, stay savvy about your healthcare plan specifics, talk costs with your providers upfront, plan for extra budget cushion, and don’t hesitate to consult financial counselors to protect both your baby’s health and your family’s finances. Planning ahead is key, but assistance is out there if challenges emerge. Here’s to a healthy, happy first year!

Frequently Asked Questions

How often do babies see the doctor in the first year.

Babies typically visit the doctor 8-10 times in the first year for wellness check-ups and vaccinations. The first visit is 3-5 days after hospital discharge, followed by exams at 1, 2, 4, 6, 9, and 12 months old. 1-2 additional sick visits for common illnesses are also common.

When should I schedule my baby’s first pediatrician appointment?

Schedule your baby’s first well visit within 3-5 days of hospital discharge . This critical newborn check ensures feeding, weight gain, and jaundice are on track. Routine well-baby visits continue monthly for the first 6 months, then every 3 months after. Seek immediate care if the baby seems ill.

Can I skip my baby’s well visits if I’m worried about costs?

No, well-baby visits are highly recommended and provide vital preventive care. Check-ups assess growth, administer vaccines, and screen development at key milestones. Speak with your pediatrician about costs if needed – they aim to ensure care is received. Never skip visits, but seek financial assistance programs if cost prohibitive.

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How Much Is A Pediatrician Visit Without Insurance?

Pediatricians recommend 7 medical visits during your baby’s first year of life to ensure optimal growth and development. A pediatrician visit without insurance costs roughly $100 on average. Even yet, when you factor in the cost of vaccines and other out-of-pocket costs, it may add up to more than $3,000 in a single year. Well-baby visits are essential, but without health insurance, they can be prohibitively expensive.

How much does it cost to see a doctor in USA without insurance?

Going to the doctor without insurance can cost anything from $300 to $600. The cost will vary based on whether you consult a specialist, if you have lab testing done, and if you have any operations done.

Why are doctor visits so expensive?

• Recent events have intensified the pressure on our very complex and costly healthcare system, making cost reduction even more important.
• Administrative waste is one of the reasons for excessive costs. Multiple payers impose a wide range of usage and billing restrictions on providers, necessitating the hiring of expensive administrative staff for billing and reimbursements.
• Pharmaceutical medications cost nearly four times as much in the United States as they do in other developed countries.
• In the United States, hospitals, doctors, and nurses all charge more than in other nations, with hospital prices rising significantly faster than professional incomes.
• Prices for pharmaceuticals and healthcare in other nations are at least partially regulated by the government. Prices in the United States are determined by market forces.

How can I get medical help without insurance?

In your location, there are likely to be community health clinics. You may be able to get these for free or at a minimal cost. These clinics provide some of the most important treatment for patients, such as preventive screenings and vaccines, without the high costs or insurance limitations of a direct primary care physician. Many of these allow customers to pay on a “sliding scale” or provide free services based on their income. Try looking up your neighborhood in the directory on

Can you go to the hospital without insurance?

Do hospitals have to treat you if you don’t have health insurance? Yes, the federal Emergency Medical Treatment and Labor Act (EMTALA) protects a person’s right to get emergency medical care regardless of their financial situation.

How much is a typical doctor’s visit?

The typical cost of urgent care without insurance for a simple visit is $80 to $280, and $140 to $440 for a more advanced treatment. Without insurance, the typical cost of a doctor’s visit is between $300 and $600. However, this does not always imply that urgent treatment is the most cost-effective option.

Do you have to pay to visit the doctor?

When seeing a doctor or any other health care provider, almost all private insurance policies require the insured person to pay a co-pay. Depending on the insurance plan, the co-payment amount varies. A visit to a primary care physician often costs $15 to $25 in co-pays. A specialist’s co-pay will often range from $30 to $50.

Before the insurance company will take over payments to a physician, most plans require the policyholder to pay a deductible. Deductibles differ greatly amongst plans, and some benefits may be available before the deductible is met. In addition, co-pays may or may not be counted against the deductible.

The co-insurance fee is usually expressed as a percentage of the entire expenditure. An 80/20 coverage, for example, requires the insured to pay 20% of the cost and the insurance company to pay the remaining 80%, but only after the insured has paid a co-pay and fulfilled the requisite deductible.

Depending on the exact test and the policy in effect, insurance may cover the cost of tests ordered by a doctor from a diagnostic center. If an insurance does not cover lab testing, the patient is responsible for paying the bill.

How do hospitals charge for services?

The fee is the financial price that a hospital establishes for services before negotiating any discounts. This may differ from the actual cost of the care or the amount paid for it.

A hospital’s revenue for each service is virtually usually lower than the amount charged. Hospitals do not get billed charges for the following reasons:

• Medicare and Medicaid, for example, often pay health-care providers significantly less than the reported amount. The government is the sole determiner of these payments. The payment rates for government-funded services are not negotiable by hospitals.
• On behalf of the people they represent, commercial insurers or other consumers of health care services frequently negotiate savings with hospitals.
• Hospitals have systems in place that allow low-income patients to get free or reduced-cost care.

The fee amount is usually the starting point for negotiations between hospitals and health care purchasers. While the charge structure of each hospital may differ in significant ways, charges provide a consistent, if imperfect, approach to compare health-care expenses.

What happens if you never pay hospital bill?

After a time of nonpayment, the hospital or health care facility would most likely sell outstanding medical bills to a collection agency, which will seek to recuperate its investment in your debt. The time it takes for a debt to be sent to collections varies depending on the health care provider, region, and service. However, once the debt is in collections, collections agencies may phone, write, or text you to request repayment. Collection listings can stay on your FICO credit report for up to seven years, so having a bill in collections can hurt your credit score.

Can the ER turn you away?

In an emergency, both public and private hospitals are barred by law from refusing care to a patient. Congress passed the Emergency Medical and Treatment Labor Act (EMTLA) in 1986, which expressly prohibits the rejection of care to destitute or uninsured individuals due to a lack of financial means. It also forbids unnecessarily transferring patients while they are receiving care and prohibits the interruption of therapy after it has begun, rules that prevent patients who are unable to pay being dumped on other institutions. In the absence of public hospitals, the treatment of impoverished and uninsured patients is a significant financial drain on the health system.

• Introduction
• Article Information

Out-of-pocket costs included costs associated with procedures (eg, laboratory tests, immunizations) that occurred on the same day as the wellness visit in addition to any charges for the visit itself. ACA indicates Affordable Care Act; ICD-10-CM , International Statistical Classification of Diseases, Tenth Revision, Clinical Modification .

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Shafer PR , Hoagland A , Hsu HE. Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act. JAMA Netw Open. 2021;4(3):e211248. doi:10.1001/jamanetworkopen.2021.1248

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Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act

• 1 Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
• 2 Department of Economics, College of Arts and Sciences, Boston University, Boston, Massachusetts
• 3 Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts

In the US, both Medicaid and the Children’s Health Insurance Program exclude well-child care from cost sharing, but out-of-pocket costs present a barrier to accessing preventive services for privately insured children. 1 The promised elimination of these costs is a popular provision of the Affordable Care Act (ACA). Although the proportion of well-child visits with out-of-pocket costs declined from 73% before passage of the ACA to 49% in 2011 and 2012, 2 the evolution of trends in out-of-pocket costs is unknown. We used national claims data to describe cross-sectional trends in well-child visits with out-of-pocket costs from 2006 through 2018.

This cross-sectional study was deemed exempt from review, and the requirement for patient written informed consent was waived by the Boston University Institutional Review Board because deidentified data were used. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. We used health insurance claims from 2006 through 2018 from children aged 0 to 17 years with full-year coverage each year; claims were obtained from the IBM MarketScan Commercial Claims and Encounters Database. 3

We focused on 2 outcomes: the proportion of children who had an office or outpatient visit without a wellness visit and the proportion of wellness visits resulting in an out-of-pocket cost, which were calculated annually during the study period. We stratified the sample by 2 age groups (0 to 5 years and 6 to 17 years) because these groups have a different recommended frequency of visits for wellness and other preventive services. 4 Diagnosis codes from the International Classification of Diseases, Ninth Revision (visits before October 2015) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (visits in October 2015 and after) and Current Procedural Terminology and Healthcare Common Procedure Coding System codes used to identify preventive services were obtained from the Centers for Disease Control and Prevention and were supplemented with coding guidelines from major insurers. 5

We examined trends in visit volumes to ensure that compositional changes did not explain the findings and assessed the delivery of preventive services during non-wellness visits. We plotted the trends over time and tested for significance using linear regression. P  < .05 was considered to be statistically significant, all P values were 2-sided. Data were analyzed from June 10, 2020, to January 15, 2021, using SAS, version 9.4 (SAS Institute, Inc) and Stata, version 16 (StataCorp).

The sample consists of 88 863 727 person-years from privately insured children in 48 states, with a total of 371 573 184 visits across the study period from 2006 through 2018 ( Table ). The mean (SD) age of participants was 9.19 (5.09) years, and 15 945 616 of 31 247 534 participants were male (51.03%). The proportion of children with at least 1 office or outpatient visit and without a wellness visit declined from 39.3% in 2006 to 29.0% by 2018 (coefficient on linear time trend: −0.79 percentage points; 95% CI, −1.11 to −0.47; P  < .001) ( Figure , A). The volume and relative share of total visits per child (coefficient on linear time trend: 0.01 visits; 95% CI, 0.01-0.02; P  = .03) and wellness visits per child (coefficient on linear time trend: 0.02 visits; 95% CI, 0.01-0.02; P  < .001) remained stable over time ( Figure , B). Older children had office visits or outpatient care without a wellness visit at higher rates than younger children during the study period ( Figure , A). The percentage of wellness visits with an associated out-of-pocket cost declined from 54.2% in 2010 (the year that the ACA was passed) to 14.5% in 2018 (coefficient on linear time trend: −5.63 percentage points; 95% CI −6.96 to −4.31; P  < .001) ( Figure , C). In addition, the percentage of non-wellness visits with associated preventive services increased approximately 60%, from 1.8% in 2006 to 3.7% in 2018 (coefficient on linear time trend: 0.09 percentage points; 95% CI, 0.03-0.15; P  = .005).

Following passage of the ACA, engagement of privately insured children in well-child care increased and the proportion of families incurring out-of-pocket costs for this care declined. However, approximately 1 of 7 wellness visits still results in out-of-pocket costs. Delivery of preventive services is increasing during non-wellness visits, indicating that providers may be encouraging prevention at any opportunity. This study is limited because specific insurers were not analyzed; however, there is considerable overlap in preventive coding guidelines, and we believe that our coding scheme is inclusive of federal guidance and several major insurers. There are several reasons why parents still receive unexpected bills for well-child care but the continued decline in costs as a barrier is encouraging. 6

Accepted for Publication: January 20, 2021.

Published: March 12, 2021. doi:10.1001/jamanetworkopen.2021.1248

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2021 Shafer PR et al. JAMA Network Open .

Corresponding Author: Paul R. Shafer, PhD, Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany St, Talbot 340 West, Boston, MA 02118 ( [email protected] ).

Author Contributions : Dr Shafer and Mr Hoagland had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Shafer.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Shafer, Hoagland.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shafer, Hoagland.

Administrative, technical, or material support: Hoagland.

Supervision: Shafer.

Conflict of Interest Disclosures: Mr Hoagland reported receiving a Student Summer Research Award from the Boston University Institute for Health System Innovation and Policy. No other disclosures were reported.

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Doctor Visits

Make the Most of Your Baby’s Visit to the Doctor (Ages 0 to 11 Months)

Take Action

Babies need to see the doctor or nurse for a “well-baby visit” 6 times before their first birthday.

A well-baby visit (also called a checkup) is when you take your baby to the doctor to make sure they’re healthy and developing normally. This is different from visits for sickness or injury.

At a well-baby visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask any questions you have about caring for your baby.

Learn what to expect so you can make the most of each well-baby visit.

Well-Baby Visits

How often do i need to take my baby for well-baby visits.

Babies need to see the doctor or nurse at least 6 times before their first birthday. Your baby is growing and changing quickly, so regular visits are important.

For most babies, the first well-baby visit is 2 to 3 days after coming home from the hospital. After that first visit, babies need to see the doctor or nurse when they’re:

• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old

If you’re worried about your baby’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my baby is growing and developing on schedule.

Your baby’s doctor or nurse can help you understand how your baby is developing and learning to do new things — like smile or turn their head to hear your voice. These are sometimes called “developmental milestones.”

At each visit, the doctor or nurse will ask you how you’re doing as a parent and what new things your baby is learning to do. They may also ask how you’re feeling and if you need any support.

By age 1 month, most babies:

• Hold their hands in tight fists
• Move their arms in jerky motions
• Focus their eyes on something 8 to 12 inches away
• Like sweet smells

See a complete list of milestones for babies age 1 month .

By age 2 months, most babies:

• Lift their head when lying on their stomach
• Look at your face
• Smile when you talk to them
• React to loud sounds

See a complete list of milestones for kids age 2 months .

By age 4 months, most babies:

• Bring their hands to their mouth
• Make cooing sounds
• Hold toys that you put in their hand
• Turn their head to the sound of your voice
• Make sounds when you talk to them

See a complete list of milestones for kids age 4 months .

By age 6 months, most babies:

• Lean on their hands for support when sitting
• Roll over from their stomach to their back
• Show interest in and reach for objects
• Recognize familiar people
• Like to look at themselves in a mirror

See a complete list of milestones for kids age 6 months . 

By age 9 months, most babies:

• Make different sounds like “mamamama” and “bababababa”
• Smile or laugh when you play peek-a-boo
• Look at you when you say their name
• Sit without support

See a complete list of milestones for kids age 9 months . 

What if I'm worried about my baby's development? 

Every baby develops a little differently. But if you’re worried about your child’s growth and development, talk to your baby’s doctor or nurse. 

Learn more about newborn and infant development .

Take these steps to help you and your baby get the most out of well-baby visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your baby has received and results from newborn screenings. Read about newborn screenings .

Make a list of any important changes in your baby’s life since the last doctor’s visit, like:

• Falling or getting injured
• Starting daycare or getting a new caregiver

Use this tool to  keep track of your baby’s family health history . This information will help your doctor or nurse know if your baby is at risk for certain health problems.

Ask other caregivers about your child.

Before you visit the doctor, talk with others who care for your child, like a grandparent, daycare provider, or babysitter. They may be able to help you think of questions to ask the doctor or nurse.

What about cost?

Under the Affordable Care Act, insurance plans must cover well-baby visits. Depending on your insurance plan, you may be able to get well-baby visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-baby visits. Find a health center near you and ask about well-baby visits.

To learn more, check out these resources:

• Free preventive care for children covered by the Affordable Care Act
• How the Affordable Care Act protects you and your family
• Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions to ask the doctor..

Before the well-baby visit, write down a few questions you have. Each well-baby visit is a great time to ask the doctor or nurse any questions about:

• How your baby is growing and developing
• How your baby is sleeping
• Feeding your baby breastmilk or formula 
• When and how to start giving your baby solid foods
• What changes and behaviors to expect in the coming months
• How to make sure your home is safe for a growing baby

Here are some questions you may want to ask:

• Is my baby up to date on vaccines?
• Is my baby at a healthy weight? How can I make sure they’re getting enough to eat?
• How can I make sure my baby is sleeping safely — and getting enough sleep?
• How can I help my baby develop speech and language skills? What kind of books can I read to my baby?
• Is it okay for my baby to have screen time? How much?
• How do I clean my baby's teeth?

Take notes so you can remember the answers later.

Ask what to do if your baby gets sick.

• Make sure you know how to get in touch with a doctor or nurse when the office is closed
• Ask how to reach the doctor on call — or if there's a nurse information service you can call at night or on the weekend

What to Expect

Know what to expect..

During each well-baby visit, the doctor or nurse will ask you about your baby and do a physical exam. The doctor or nurse will then update your baby’s medical history with any new information.

The doctor or nurse will ask questions about your baby.

The doctor or nurse may ask about:

• Behavior: Does your baby copy your movements and sounds?
• Health: How many diapers does your baby wet each day? Does your baby spend time around people who are smoking or using e-cigarettes (vaping)?
• Safety:  If you live in an older home, has it been inspected for lead? Do you have a safe car seat for your baby?
• Activities: Does your baby try to roll over? How often do you read to your baby?
• Eating habits: How often does your baby eat each day? How are you feeding your baby?
• Family: Do you have any worries about being a parent? Who can you count on to help you take care of your baby?

Your answers to questions like these will help the doctor or nurse make sure your baby is healthy, safe, and developing normally. Be honest, even if you’re worried you’re doing something wrong — the doctor or nurse is there to help you.

Physical Exam

The doctor or nurse will also check your baby’s body..

To check your baby’s body, the doctor or nurse will:

• Measure height, weight, and the size of your baby’s head
• Take your baby’s temperature
• Check your baby’s eyes and hearing
• Check your baby’s body parts (this is called a physical exam)
• Give your baby any vaccines they need

Learn more about your baby’s health care:

• Read about what to expect at your baby’s first checkups
• Find out how to get your baby’s shots on schedule

Content last updated July 10, 2024

Reviewer Information

This information on well-baby visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by:

Sara B. Kinsman, MD, PhD Director, Division of Child, Adolescent and Family Health Maternal and Child Health Bureau Health Resources and Services Administration (HRSA)

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Cost of pediatrician visit by state

The following estimated costs are based on cash prices that providers have historically charged on average for pediatrician visit and will vary depending on where the service is done. The prices do not include the anesthesia, imaging, and other doctor visit fees that normally accompany pediatrician visit.

When should you see a pediatrician?

You should see a pediatrician with your child at least once per year for a general physical exam.  Your child should see a pediatrician more frequently depending on age, with infants and toddlers requiring closer monitoring for routine vaccinations and to ensure that the child is growing properly and achieving developmental milestones.

Typically, an infant and toddler is seen every few months for routine vaccinations, up to age 4 years old, and every year thereafter for a general physical exam, up to age 18 years old, although some physicians will treat patients up to age 21 years old.

Additionally, if your child is sick, including with a fever, seizure, or a medical issue that is of concern, you should book an appointment with the pediatrician for further evaluation.

What can I expect at a pediatric appointment?

Your expectations for a pediatric appointment will depend on the nature of the office visit.  If your child is feeling well and the visit is routine, you can expect to have vital signs taken, height and weight recorded, and the vaccination record reviewed.  Your child should receive a routine physical exam.  The pediatrician will likely speak with you about developmental milestones and growth issues that are routine for the child’s age.  He or she will likely ask you questions about how your child is functioning at home and at school, both socially and academically.  Healthy lifestyle practices should be discussed, including dietary intake, sleep habits, and hygiene practices.  The physician will give you advice on what to expect of your child as he or she grows over the next year.  This is also an opportunity to discuss any concerns you have about your child’s well-being or receive answers to issues you are noticing with your child’s development.

If your child is ill and the appointment is scheduled as a sick visit, you can expect your child’s vital signs, including temperature, to be taken and height and weight to be recorded.  You will be asked questions about the nature of your child’s illness, including what symptoms you are noting, and when the problem started.  The doctor will examine your child and may prescribe medication or order further testing as appropriate for the condition.

What does a pediatrician do at a checkup?

At a routine checkup, the pediatrician will assess the child’s height and weight, measure vital signs including blood pressure, heart rate, and temperature, and review his or her immunization record.  The physician will also conduct a head-to-toe physical exam and order labwork or other testing as might be indicated. 

You will be given advice about the prevention and treatment of common illnesses and conditions that might occur.  The doctor should also discuss how to assess for the physical, mental, and emotional well-being of your child.  The specific information on these topics depends on the child’s age.

When should a baby’s first pediatric appointment be?

The baby’s first pediatric visit is usually 3-5 days after birth.  Be sure to dress your baby comfortably with clothing that is easy to remove, so the doctor can do a careful physical exam.  The doctor will be measuring the baby’s head circumference, evaluating ears and eyes, listening to his heart, and inspecting the hips and genitals, among other things.  You should bring your insurance information, and discharge paperwork from the hospital, including the baby’s weight at time of discharge home after birth.  You will be given information about what to expect in terms of your child’s growth and development, as well as things to look out for, and which conditions warrant further evaluation by the doctor.

What is included in a well-child visit?

The well-child visit includes a check of vital signs, recording of height and weight, and assessment of the vaccination record.  A physical exam is performed to ensure that your child is developing appropriately. Depending on your child’s age, you will be given information on what to expect over the coming year, in terms of your child’s physical, emotional, and social development.  This can include tips on healthy habits for your elementary school child, and information about sexual development for preteens and teenagers. 

During these visits, you should also discuss any concerning behaviors or physical issues you are noting with your child, so they can be evaluated properly.

At what age do well child visits stop?

Typically, well child visits at pediatrician’s office end at age 18 years old, although some accept patients until age 21 years old.  After this time, your child should have yearly visits with a primary care physician, which is typically either a family practitioner or an internal medicine doctor (internist).  These physicians can monitor, evaluate, and treat all the typical health issues and illnesses in adults.

If your child reaches the age limit for your pediatrician’s office, you can ask for his or her recommendation for a trusted primary care doctor.  You should also request a copy of your child’s medical records, so the new physician has all the necessary background medical information.

* Savings estimate based on a study of more than 1 billion claims comparing self-pay (or cash pay) prices of a frequency-weighted market basket of procedures to insurer-negotiated rates for the same. Claims were collected between July 2017 and July 2019. R.Lawrence Van Horn, Arthur Laffer, Robert L.Metcalf. 2019. The Transformative Potential for Price Transparency in Healthcare: Benefits for Consumers and Providers. Health Management Policy and Innovation, Volume 4, Issue 3.

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Your actual costs may be higher or lower than these cost estimates. Check with your provider and health plan details to confirm the costs that you may be charged for a service or procedure.You are responsible for costs that are not covered and for getting any pre-authorizations or referrals required by your health plan. Neither payments nor benefits are guaranteed. Provider data, including price data, provided in part by Turquoise Health.

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Preventive Care

Most plans must over a set of preventive services – like shots and screenings – at no cost to you.

For example, depending on your age, you may have access to no-cost preventive services such as:

• Blood pressure ,  diabetes , and  cholesterol tests
• Many cancer screenings, including  mammograms  and  colonoscopies
• Counseling on such topics as  quitting smoking ,  losing weight ,  eating healthfully ,  treating depression , and  reducing alcohol use
• Regular  well-baby and well-child visits
• Routine  vaccinations against diseases  such as measles, polio, or meningitis
• Counseling, screening, and vaccines  to ensure healthy pregnancies
• Flu shots  and other vaccines

Why am I being charged a fee for preventive care?

Your health plan may charge a fee if:

• Out-of-network providers: These services are free only when delivered by a doctor or other provider in your plan’s network. Your health plan may allow you to receive these services from an out-of-network provider but may charge you a fee.
• Office visit fees:  Be aware that your plan can require you to pay some costs of the office visit if the preventive service is not the primary purpose of the visit.
• Grandfathered plans:  If your plan is “ grandfathered ,” these benefits may not be available to you.
• Talk to a health care provider to know which covered preventive services are right for you — based on your age, gender, and health status. 
• Contact your insurance company if you have questions about your plan or fees.

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Your Guide to Preventative Care Appointments: Costs and More

Can an apple a day keep the doctor away? Probably not; however, staying away from the doctor’s office can feel like a money-saving measure. But did you know that you’re legally entitled to a number of free health screenings and vaccinations each year? 

Under the Affordable Care Act, most insurance policies, including Medicaid and Medicare, are required to offer certain preventive healthcare services at no cost to you — with a couple of disclaimers, which we’ll discuss below. If you don’t have insurance coverage, many services are still available for free or at heavily discounted rates through community clinics, local nonprofit organizations and other places. As we enter a new year, here are several types of doctor’s appointments that are typically fully covered.

What’s a preventive service and why do we need them?

Chronic conditions, many of which are preventable, cost the US hundreds of billions of dollars a year. Almost 6 in 10 Americans today live with at least one chronic health condition and nearly 30 percent struggle with three or more, according to 2017 research from the nonprofit RAND Corporation. 

Preventive screenings can improve overall health, identify acute diseases, prevent or detect cancer at earlier stages and help patients address conditions like obesity or high cholesterol sooner rather than later. 

“Early detection and prevention through regular check-ups can save you a lot of money and discomfort down the road,” says Dr. Amy Faith Ho, a Dallas-based emergency medicine physician. “Treating a medical problem is both onerous and expensive, but preventing a medical issue before it becomes a problem is often simple and free.”

In fact, the Patient Protection and Affordable Care Act (ACA) requires private insurance providers to offer access to preventive services . These services must be offered without cost-sharing, which means your insurance company cannot charge you a coinsurance or copay. 

These services include:

• Preventive services with an “A” or “B” grade rating by the US Preventive Services Task Force (USPSTF)
• Routine vaccines for adults and children recommended by the Advisory Committee on Immunization Practices (ACIP) 
• Preventive services for infants, children and teens recommended by the Health Resources and Services Administration (HRSA) 
• Women-specific care and screenings recommended by the HRSA

Let’s break these preventative screenings down…

Your annual physical.

These are some standard preventive screenings and health metrics that you and your primary care provider should track on a regular basis. Your doctor will typically go over these benchmarks, including by taking various blood pressure and cholesterol levels, in an annual physical.  

Depending on your health habits and family health history, your PCP may order some additional tests or screenings, such as a colonoscopy if you’re at high risk for colon cancer, which may be covered as preventive care. If your results come back clean, you will likely be asked to repeat the exam at a later date, which should also be covered under preventive care. 

If you don’t have a PCP or can’t get a timely appointment with your usual doctor, you may be able to reach out to your regional clinic or community health center, which may be able to accommodate you more quickly. As always, be sure to confirm that the facility you visit is in-network with your insurance provider to avoid paying for your visit out of pocket. Physicals can range anywhere from $100 to $300 out of pocket. 

Ob-gyn checkups

People with uteruses are eligible for annual wellness checks under the ACA. Most health insurance plans will cover one visit each year, and uninsured people can often access care through Planned Parenthood or local community health centers at no or reduced cost. 

Here’s what you can expect at a visit with an ob-gyn.  

Pregnancy treatment

Private health insurance and Medicaid cover preventive services for pregnant people. (More than 40 percent of pregnant people in the US are covered by Medicaid, according to Planned Parenthood .)

If you’re pregnant, these appointments are typically covered: 

• Hepatitis B screening for all pregnant people at the first prenatal visit
• Gonorrhea screening for higher-risk patients
• Gestational diabetes screening at 24 weeks or later, or earlier for high-risk patients
• Rh incompatibility screening
• Preeclampsia prevention and screening for patients with high blood pressure
• Breastfeeding support and counseling
• Maternal depression screening at well-baby visits 
• Expanded tobacco intervention and counseling for pregnant tobacco users
• Urinary tract or other infection screening

Well-baby and well-child visits

Finding a trustworthy pediatrician who is in your insurance network is incredibly important, since babies and children need so much attention across many areas of development and growth. Most insurance plans will cover preventive screenings and checkups offered by health care professionals within your network. 

If you don’t have private health insurance, your child may be eligible for coverage under the Child Health Insurance Programs (CHIP) through both Medicaid and separate CHIP plans. 

Infants need six “well-baby” visits during the first 11 months of life, according to the US Department of Health and Human Services. During these visits, your pediatrician will check standard metrics such as physical height and weight, overall health and reflexes, and developmental milestones. 

Free preventive care for older children includes standard wellness check-ins, as well as behavioral assessments and vision and hearing screenings, with additional testing as needed for children with high risk of obesity, lead exposure or oral health issues. Vaccinations are also covered under preventive care guidelines for common diseases such as chicken pox, flu, measles, mumps and rubella (MMR) and diphtheria, tetanus and pertussis (DTaP).

Note that children often get sick or injured and require doctor visits for reasons beyond preventive visits. If you schedule a wellness check-in at the same time as an appointment for a fever, you may still be billed for the illness portion of the visit, even if the check-up is covered under preventive care (more on this below).

Sexually transmitted infection testing

Sexually active adults and teens should regularly screen for common sexually transmitted infections, especially since many can develop without any noticeable symptoms. 

Unfortunately, insurance coverage varies widely when it comes to STI testing, since there are a number of preventive service exclusions. Under the ACA, testing for the following STIs is covered for the following demographics without requiring a copay or deductible: 

There are many STIs that aren’t on this list but which can still endanger your health or that of other people.

If you are sexually active, it’s a good idea to get tested on a regular basis regardless of cost, especially if you have more than one sexual partner. Your local community health center or any Planned Parenthood facility can help you schedule a test. Each test panel can cost up to $250 out of pocket, although health insurance can reduce the cost in many cases, while other facilities may offer discounted or free testing based on financial need. 

COVID-19 vaccines

COVID-19 vaccines are free for anyone living in the US, regardless of immigration or health insurance status, and can be administered to most people six months or older. 

Additional vaccines

Many vaccines for common diseases are free or offered at reduced cost for most adults and children, including those on Medicare and Medicaid. Dosages, recommended ages and populations vary based on the illness.

The fine print

When scheduling your preventive care appointments, keep these two crucial details in mind to avoid getting an unexpected bill in the mail. 

Make sure you see a doctor within your insurance network

Preventive services under private insurance are only free when you see a healthcare provider who is in-network with your insurance company. If the doctor you see isn’t on your carrier’s list of approved medical professionals, your insurance provider isn’t obligated to cover your visit. You can find an in-network doctor through Zocdoc. 

At the beginning of the year, it’s a good idea to check with your healthcare providers to ensure they all have your latest insurance paperwork and that none of them have left or changed the terms of their agreement with your network.

Don’t tack on other issues during a preventive visit

Keep in mind that ACA-covered preventive services are only free for preventive issues, which include health concerns that haven’t been diagnosed yet. It may make logical sense to discuss all of your ailments during your preventive wellness check. But if you do so, your doctor could technically bill your insurance for a standard office visit.

What should you do instead? Before you get too detailed with listing your ailments, double-check with your doctor to make sure that you’re discussing information that still qualifies under preventive care.

If you want to discuss an issue that falls outside of the realm of a wellness exam, schedule a follow-up appointment to do so at another time. Alternatively, you can take care of any and all business during a single appointment — just know that visit may not qualify for free coverage under your insurance plan. 

Need a doctor? Find one on Zocdoc.

Katherine writes about personal finance, travel and healthcare for a number of media outlets including The Points Guy, NerdWallet, Business Insider and LendingTree as well as The Paper Gown. She splits her time between Austin, New York City and Taipei.

Dr. Nassim Assefi is a medical reviewer for Zocdoc.

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The Paper Gown, a Zocdoc-powered blog, strives to tell stories that help patients feel informed, empowered and understood. Views and opinions expressed on The Paper Gown do not necessarily reflect those of Zocdoc, Inc.

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The Cost of Not Having Health Insurance

There are multiple reasons why people think they don’t need health insurance. Perhaps they are healthy and don’t see the need. Maybe they think their premiums are too high. When it comes down to it, the cost of not having health insurance is too high. Discover the price comparison of insured and uninsured health care below:

Broken Tailbone Treatment Cost With Insurance: $10 to $40+ Without Insurance: $250 to $700+

ACL Reconstruction Cost With Insurance: $800 to $3,000 Without Insurance: $20,000 to $50,000

Mammogram Cost With Insurance: No Charge or Copay Without Insurance: $80 to $212

Brain MRI Cost With Insurance: $20 to $100+ Copay Without Insurance: $1,000 to $5,000

Cardiac MRI Cost With Insurance: $20 to $100+ Copay Without Insurance: $1,000 to $5,000

Hernia Repair Cost With Insurance: $700 to $2,000 Without Insurance: $4,000 to $11,000

Emergency Room Visit Cost With Insurance: $50 to $150 Copay Without Insurance: $150 to $3,000+

Human Papillomavirus Vaccine Cost With Insurance: $30 to $120 Without Insurance: $400 to $500

Well Baby Doctor Visit With Insurance: Copays typically $10 to $30 per visit Without Insurance: Around $95 per visit

Even if you don’t plan on using your health insurance regularly, your ten essential health benefits are covered by any qualified health plan. If an accident lands you in the emergency room, you can rest assured knowing your health insurance has you covered.

Nevada Health Link can connect you with an in-person assister in your area that will help you enroll in a qualified health plan. Start your open enrollment process before the window closes on Dec. 15. If you miss open enrollment, certain qualifying life events such as job loss, income change, marriage/divorce and others, can make you eligible for a special enrollment period .

Note: all data comes from Cost Helper.

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