for non-preventative services.

The well-child visit is a preventive services visit. Insurance typically covers these 100% for patients, with no copay, but also has strict requirements on what counts as preventive services. A doctor, NP, or PA can't call any visit a well-child visit. You can't include anything non-preventative in a well-child visit. It will be denied when submitted to insurance and billed separately.

For anything that is not part of a preventive service (not part of a typical well-child visit), it then falls under a different billing category, often called a "sick" visit or "new concern" visit or "follow-up" visit. The associated charge can either be based on time spent, or on the complexity of medical decision making (which is determined in a regimented/regulated way, and not just whatever complexity the pediatrician decides)

Again, the system is terrible, but this is the system we have and that a pediatrician has to work within.

If a pediatrician documents a well-child visit, and also a "new concern" that included medical decision making that resulted in a referral, you now have two different "visits". Some parents appreciate not having to make a new appointment and come in for the "new concern" visit/question. Some parents would prefer that only issues covered under the no copay well-child visit be addressed, so they don't receive any bill for that visit.

No matter what the pediatrician submits as professional charges in the EMR, on the back-end the coders for the practice will submit two charges, one for the well-child visit and one for the "new concern" visit. This isn't double dipping by insurance standards. The way the insurance company set it up is that the way you described your visit the pediatrician provided two separate services, so there were two separate charges.

Insurance considers both under-coding and over-coding as fraud. So if they hadn't submitted the "new concern" visit charge, technically that would have been considered fraud just as much as submitted charges for services they didn't perform.

I can't say enough, the system is terrible. I'm not saying this is a good system. But the way the system is set up, you asked the pediatrician to perform two services: a well-child visit and a new-concern visit. They performed both of those, and complied with regulations that they neither overcode nor undercode, and so you had two charges for the two visits submitted to insurance. The lack of transparency, the high out of pocket cost, all they time you spent and weren't able to get ahold of anyone are all super frustrating and are all parts of why our healthcare system is a mess. I'm sorry you had to go through that.