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I’ve been grumping and grousing about this subject for the past couple of weeks here at the FireHouse. I’ve finally decided to write about it. Here goes nothing. Stay with me. It’s in your pocketbook’s best interest.
We received a bill two weeks ago for LittleBrother’s four month WellBaby checkup. Not an explanation of benefits that says, “This is not a bill.” No. We received a bill-bill. For $282.00. FireDad opened it first and asked me, without me viewing it first, why insurance didn’t cover anything. I got up, walked across the room, looked at the bill and began yelling.
After a number of phone calls, one of which a customer service representative from our health insurance laughed at me when I asked for a manager, I found out that my Husband’s employer chose a coverage program in which WellBaby visits are “capped.” That’s right. Capped. What’s the cap?
$500.00. For the entire first year.
To give you an idea, especially if you don’t deal with bills, have great (read: better than ours) insurance or don’t yet have children, the first WellBaby appointment, at two months of age, was $467.00. What exactly was $500.00 supposed to do for us? How exactly was $500.00 supposed to last for an entire year? If the CDC is so gung-ho on vaccinating all children, why are health insurance companies allowed to place a cap that makes it impossible for families who make too much money to receive said vaccinations at a clinic to get said vaccinations? Shouldn’t they just simply be covered, caps be darned?
After talking with a few insurance reps who happen to be friends of mine, our only option would be to take it up with FireDad’s employer. That’s not something that would be wise to do. If you’re not familiar with city government jobs, if you want to keep your job and, as such, your pension through your retirement, making waves is not the way to go about it.
And yes, I “should have known” about the cap. I should have read the certificate of benefits book from cover to cover. (Have you?) But I have never even heard of a cap on WellBaby visits. I didn’t know to look for such a thing! To be honest, if I had read it prior to this mess, I would have thought that was so people couldn’t schedule extra visits, meaning that as long as you stuck to your normal WellBaby schedule of 2, 4, 6 and 12 months, all would be well. I would have been wrong. As a side note, this was not in place during BigBrother’s first year. We further confirmed this with old EOB’s and a discussion with another Fire Family whose older daughter is the same age as BigBrother. Their family is now expecting a new baby and they are grateful that we let them know about this cap ahead of time so they can budget properly. I mean, they’re properly ticked off, too, but happy that they know.
And so, we’re rebudgeting our entire year. To be honest, I’m taking this as a sign to further delay certain vaccinations. What started out as a reduced rate approach to vaccinations is suddenly turning into a turtle’s pace. And no, we can’t just jam them all into next year because every year after the first year has a $150 cap (which is fine for one vaccination and one visit).
Quite honestly, I think it’s lower than low that our insurance company is even offering this as an option for businesses to choose. Perhaps the person choosing the benefit plan for my husband’s employer doesn’t have children or parented their children umpteen years ago when $500.00 would have covered a year’s worth of appointments and vaccinations. Perhaps they parented children so long ago that WellBaby visits didn’t exist. And so insurance companies are making out because people aren’t understanding what they’re signing their employees up for… and we’re left with mounting bills and customer service representatives who laugh at us and tell us “that’s too bad.”
I chose to write this, after much hemming and hawing, because I decided that my experience could benefit other parents. Check your insurance now. Call and ask if there is a cap on your WellBaby visits (for any year). If there is, ask why. If you have the cap and won’t risk losing your job if you fight it, fight it. And if not, at least you now know to budget appropriately. There’s nothing worse than being caught blind and having people tell you that you should have known to look for something that you didn’t even know existed. Now you know. Make the best use of that knowledge.
21 Responses to “Warning to Parents About Health Insurance & WellBaby Visits”
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My name is Jenna, aka FireMom. I blog here, 
I’m just shaking my head here. Well baby visits? Not like you have oodles of free time, but I’d be looking up my state representative. That is bogus. I’d be tempted to take my kid in for the, um, sniffles at 2, 4, 6, 9 and 12 months. We delay/selectively vax and I guess I consider myself lucky that our peds office doesn’t charge for a nurse’s visit for that. Ack. I’m so sorry that you got this unexpected surprise and don’t really have recourse w/ the employer.
We have the same insurance provider as you, only we’re on the state govt. employee plan. Our WellBaby visits are covered 100% at the moment.
However, they’ve screwed us on other things more than once. Including my pregnancy care, where they tried to tell me a non-stress test when I was past my due date was unnecessary, along with several other problems.
It’s ridiculous that many of the “cheaper” plans cut out well-checks. Last I checked, it was cheaper to prevent health problems than it was to let them get to a serious disease. If people want to cut down on health care costs, then preventative and acute care needs to be the top priority. Many chronic diseases could have been prevented or lessened with early care.
As a student nurse right now, I can’t tell you how often I see this in the hospital I’m doing my clinical hours at. So many people are in bad condition, undergoing complicated, dangerous, and expensive procedures, all because they couldn’t afford early care due to insurance.
It’s a completely backwards system.
Our insurance is a headache, too. The health department offers vaccinations at a very low rate–a lot cheaper than the dr office.
Our insurance has a $6000 family deductible. Now, if you are healthy this doesn’t matter. However, since I am pregnant this year and the baby is due in August we will hit that $6000. We were floored when we realized that the deductible was for everything. Prenatal care, infant hospital care, etc. I hate insurance companies. They all stink. I may have to rant about my recent issues with insurance compaines in the next few days.
My husband recently went “into the field” with his employer, and along with a relocation to another state, we also had to join with a new insurance carrier. It has been TERRIBLE. Apparently his company only offers the really good insurance where they have lots of employees. Well…my husband is THE employee in this huge region (hence “the field”), so we just get the slim pickins’. I’m not sure knowing this would have affected our decision to take the promotion and make the move, but it really has thrown us for a loop. I have to say, I was totally naive about it and now we’re paying the price (and when I say “price,” I mean PRICE!).
Our previous insurance covered the first 4 well baby at 100% and then we had a $250 yearly cap after that… Luckily we switched right after Cameron’s 4th visit!
I do know, you can usually (in my state anyway) get shots from the health department. A friend had physician coverage but it did not cover shots, so she took her son to the health department for shots.
Insurance stinks. Our administrater changed last month and they have screwed ours up and I fear we may end up starting our dedcutible over now… Yuck!
i live in canada, now, though i was born and raised in texas. i want every single person who reads your excellent and always timely post to realize that just shopping around for a better insurance provider is not enough. it is time for americans (myself included, though i am no longer resident) to INSIST (i.e. make it a condition of employment for your elected governmental respresentatives) upon the provision of single-payer health care.
the insurance-for-profit system that exists in the states is a scam and a shame. and i mean shame in the good old-fashioned sense of the word, not just as unfortunate.
the canadian system is by no means perfect, but i rest better at night knowing that our family will never be faced with bankruptcy because someone gets sick or injured. i rest better knowing that my government (or at least one of them – dual-citizenship, you know) has enough forethought to realize that keeping my family health preventatively benefits not just our family, but the entire society in which we live.
Hi–found your site from your comment on Mommyology. First, I wanted to comment on your comment there….
I know exactly how you feel with a child not following the curve that docs think they should. Both of my boys were/are small for their age. My youngest is even smaller than his brother was. While my 5 year old is still on the small side, he is finally on the charts, so the doctors don’t give me a hard time with him. My two year old—that’s a whole ‘nother story!! He still isn’t on the charts and at his two year check up, he wasn’t even 20 pounds. The boy eats, what am I to do?? I did agree to some testing to make sure things were okay and they found his Hgb to be low. So, we agreed to further testing—all of which came back normal. Finally they see that he is just small. I don’t know why they throw such a fit on seeing a smaller baby—with obesity (and I am) on the rise, shouldn’t it be a relief? Anyway, he mostly followed his own growth curve (not even on the charts for their growth curve), but he dropped at one point and that is why they wanted the testing. I was taking him often for them to do weight checks and they have finally stopped asking—and at the last one he had gained near a pound in the two months since his 2 year well visit—which is a HUGE gain in that amount of time for him.
Now—on to ins…. We seem to have pretty good ins. The time that it became an issues was really more an INOVA thing than ins. I have diabetes and so with my second pregnancy, I had LOTS of doctor visits. I did my research about the ins. and knew that it would only cost me $20 (yes, $20!!) for all visits and the delivery of my baby. The hospital charge was separate and I believe the co-pay on that was $100. I didn’t have to worry about any of this with my first, because my husband was in the Army. I also knew that my co-pay for specialists was $20 per visit. I had to be seen by specialists lots–a perinatologist. Towards the end of the pregnancy, I was going there twice a week for non-stress tests. I paid the co-pay each time I went. Boy was I surprised that when my baby was 6 months old I received a bill for close to $600 for those visits. Come to find out, the way INOVA bills for those visits is as an out patient. My co-pay for out patient services is $100. So, I had to pay an additional $80 for each of my visits. YUCK!! While I realize I still came out in pretty good shape for the price of having a baby, I wasn’t prepared for that. Now I know when I have to see a specialist that is connected to a hospital to ask about how they charge. If they charge as an out patient, I call around until I find one that charges as a regular visit.
Taking out a secondary personal (privately written, non-job related) insurance plan might be a more cost-effective alternative to just paying the uncovered out-of-pocket expenses. It’s possible your children could be covered under a secondary insurance (that would pay for whatever your primary insurance doesn’t) for a reasonable price that would be a predictible expense.
Yeah. sucks right? I found out after my son’s 4 year (and supposedly last) vaccination that my husband’s new job insurance doesn’t cover vaccines. AT ALL. So that puts a cramp on trying to conceive, right? New baby!! yeah! $2500 worth of shots in a year ?!?!?! WTH??
And I said “supposedly” last because when we went in for his 5 year check up to go to school, I told him that he didn’t have any shots. We had completed those last year. Then wouldn’t you know it, the CDC has added a booster to the chicken pox… that was one u.n.h.a.p.p.y 5 year old.
I was going to comment along the same lines as “ru”. I live in Canada and I totally take advantage and forget how lucky we are to not have to worry about things like that. We go to the doctor and it’s free, we need a cast and it’s free, we need an operation and it’s free. And something as universal about vaccinations to protect the youngest and most vunerable of our society only receive the vaccinations if parents can pay for them? That’s just crazy!
Wow that is crazy… and sad that insurance companies would put limits on things like childhood vaccinations, yet would cover prescriptions for Viagra or something. GRR. Thanks for sharing this with all of us!!
It may be worth a call to your care provider. There’s a lot of flexibility in the pricing for health care, and if you’re paying out of pocket you should play the pity card and see if you can cut a break.
And, if you lived in the Burgh (where you belong!), at least you would qualify for CHP. It very much sucks that they don’t have a similar program where you are.
FireMom,
Nothing’s worse than getting a gimme-a-stroke EOB or a bona fide bill. I briefly had a $200 cap on well baby care about 7 years ago. Even back then that was exhausted when the doc walked in the door at the 2-month visit. My huz got his employer to pay for well baby care as an extracontractual payment, which meant that such claims were handled via the insurance plan’s administrator.
In Illinois, there’s a state-assisted vaccination plan available for those whose insurance will not fully cover vaccinations, and it’s administered via private pediatricians. You have to make advance arrangements with your doctor, but that’s one option. Maybe such a plan is available in your state.
I’d agree that the health department might be a better option. I took my 10 y.o. to the health dept. for some of his shots during the first year because our insurance company sucked. I was afraid to even submit a $200 vaccine charge to the insurer, and the $5 the county health dept. charged was a steal. We’re in a comfortable suburban area, and the health dept. nurses were truly professional, experts on vaccination, and our county facilities were modern and clean. The county even had shot clinics at a church blocks from my house. By the time my son was 6 months old, we had new coverage with traditional PPO coverage, and it was back to everything for the familiar office copay of $10-20 and a smooth claims process.
Good luck!
Not only should you inform your physician, but you might also check at your local health dept. for reduced (and I mean a few $ each) vaccines because many in OH do offer this service. Welcome to HMO-land. With my oldest, NO well care was covered- zilch. That was painful. At least now we had 2 visits/year.
I got a bill from my orthopedic the other day. Rye said ” what do we owe them 900 dollars for?” I said IDK..coz it’s not for fixing my arm.. that’s still broken.
I hear you. National Halthcare would be lovely. I could have my arm fixed…ah, but I dream.
Dear Firemom,
Insurance companies suck big toes. Don’t get me started on what they cover for autism-related services (ABSOLUTELY NOTHING!). Laws are supposedly changing but I’m not holding my breath.
The end.
DG
Have you looked into if your state offers a discounted shot program? IL does and it saved out butts numerous times when hubby’s insurance capped well baby at $300 for all kids in the family per year?
Most hospitals have a walk-in shots clinic that is income based, but max that has to be paid ever is 5$ per shot, and they cannot deny you for making too much. Some only hold sessions also so check that out.
Funny, I don’t even know how I got here. But, we didn’t get vaccinations for our kids (except meningitis) until they were two or older. And then, I went to the state health dept in Oklahoma City. They didn’t ask any questions as to insurance or income. Plus they have the 3 in1 shots that dr’s don’t. So instead of my kid getting stuck 3 times in one day, it was just once. i realize this doesn’t help you per se, but I figured I’d add it anyway.