Warning to Parents About Health Insurance & WellBaby Visits

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.