Home Specialities Pediatrics
High volume, low dollars
where small leaks compound
Pediatrics-experienced reviewers
chart-level review
Commercial & Medicaid
every plan you see
Revenue recovery
on claims marked paid
Nothing here is big. That's exactly why it survives.
A $40 sick visit. A $25 copay. A $30 shortfall on a new patient. Individually, none of it is worth anyone's afternoon, which is precisely why it never gets challenged. But you don't lose these once. You lose them across 15,000 visits a year, quietly, on repeat.
Across the 32 pediatric practices we've analyzed, an average of 5–8% of revenue disappears this way. On a $3M practice, that's $150K–$240K a year, the difference between a good year and a hard one, hiding in amounts too small to notice.
See what's missingWhat 5–8% looks like on a $3M practice
The 5–8% range reflects OneMed's analysis of 32 pediatric practices; the dollar figures apply that range to a $3M example practice. Your actual exposure depends on payer mix, visit mix, and workflow.
“While we're here — can you look at her ear?”
It's the most ordinary moment in pediatrics. A child arrives for a physical, and a parent mentions three days of ear pain. You examine, diagnose, prescribe. That's two distinct pieces of work in one appointment — and one of them routinely pays nothing.
One appointment. Two pieces of work.
The annual physical
growth, development, the whole check-up
paid“And the ear pain?”
exam, diagnosis, antibiotics prescribed
erased — $0Illustrative of a pattern we see constantly. Whether a same-day sick visit can be paid alongside a physical depends on the care given, documentation, and each insurer's rules.
Five leaks, none of them worth arguing about.
Each one is small. That's the trap — they're individually forgettable and collectively enormous.
The sick visit erased into the physical
A child comes in for a check-up and leaves with a diagnosed ear infection. That's the whole physical plus a real medical problem examined, diagnosed, and treated. The sick visit gets zeroed as "included in the preventive exam," so you did two jobs and got paid for one.
Vaccine work that goes unpaid
A vaccine is two things: the vial, and the work of giving it — your nurse's time, the supplies, the counselling, and the safety oversight. Insurers pay for the vial and quietly refuse the work, calling it part of the visit. You're paying staff to give shots you're not paid to give.
The new patient, repriced
A family moves to town and brings their child in for the first time. That's a full history and a comprehensive exam — and it pays more than a routine follow-up, for good reason. Insurers often reprice it to the lower rate because the child appears somewhere in their records already.
Balances that walk out the door
Your front desk is holding a phone, a crying toddler, and a check-in queue. The copay doesn't get collected. Three months later you're mailing statements and calling parents about $25 — costing more in staff time than the balance, and often ending in bad debt anyway.
Approvals lost in limbo
More of pediatrics now runs on approvals — ADHD medications, specialty prescriptions, speech and occupational therapy referrals. When a request is faxed and never tracked, the approval doesn't arrive, care is delayed, and the claim is denied for missing authorization.
Bandwidth, not effort
Your team isn't failing. Nobody can hand-check thousands of small claims a month — so the small ones win by default.
They fight denials, not shortfalls
Your team attacks claims marked denied. When one says paid, they move on — there's no reason not to. Nobody has time to ask whether 'paid' meant paid correctly.
The volume trap
Thousands of small claims a month. No team can hand-check each payment against your contracts. They triage — and the smallest losses always lose.
You can't see it from the deposit
As the owner you get one number a month. The micro-leaks on individual claims are invisible from there, and you can't manage what nothing shows you.
We watch the small stuff so you don’t have to.
Clear visibility for you as the owner, experienced people doing the reviewing, and fixes at the front desk so the leaks stop — all inside the systems you already use. No EHR change, no disruption to your clinic.
See it clearly
Our ClearView dashboard gives you a straight answer to one question: what did this work actually pay, versus what it should have? It flags the erased sick visits, the unpaid vaccine work, the repriced new patients — without changing how your staff works.
Experienced people review it
When something looks short, it goes to reviewers who know pediatric billing. They read the chart and decide whether it's genuinely owed — a person making a judgement, not a guess.
We build the appeal
If care was unfairly bundled or repriced, we draft the appeal with the exact clinical documentation needed to get the decision reversed and get you paid.
Fix the front desk
We help your team verify coverage and collect at the visit, so balances stop walking out the door — and you're not chasing $25 three months later.
The 2026 OneMed Pediatrics Profit Index.
We aggregated the anonymized results from every pediatric practice we worked with over the last 18 months — here's what surfaced once someone finally checked the claims marked paid.
32
pediatric practices analyzed
1.5M+
claims reviewed
$168K
average recovered per practice
↓38%
average bad debt
Point-of-service collections rose 31% on average. Here's where the recovered money had been hiding — note that the biggest leaks are the things you do every single day.
| Where the money was found | Share of what we recovered |
|---|---|
| Sick visits erased into physicals | 34% |
| Unpaid vaccine administration | 26% |
| Approvals and denials cleaned up | 18% |
| Front-desk collection fixes | 14% |
| New patients repriced back | 8% |
Aggregated across OneMed pediatric engagements over the trailing 18 months. Individual results vary by practice, payer mix, and starting point.