Insurance not covering well visits...

My insurance apparently does not cover all of the well visits that my Dr wants, and when he gives shots. This has never been discussed with us, we were just sent a bill for 100 bucks for each child. If I would have known that I would have had him do the shots the way the insurance wants.

I understand it is my plan, but should the people in the office know that my insurance does not cover that? I never in a million years thought that I would have to pay for a 18 month old well visit.

I already tried fighting it with the insurance company so I guess I am stuck spending 200 bucks for nothing.

Re: Insurance not covering well visits...

The Dr's DO know....but unfortunatly they dont keep track.

Heres the thing ( I work in insurance)....Insurance companies follow the NYS Mandate for Well visits. Its a certain number of visits per " age band"...

What Dr's do is charge you for a well visit, and say you go back 3 week slater for a shot...they charge you again for another well visit...

Shots should be SEPERAT then then the well visit, unless your truly having them both on the same day.

The amount of Well visits allowed is a LOT....No -one shoud need to take their babies for more well visits then NY allows...

I would 100% fight it with the Dr's office and make sure that you did indeed have well Visits at each time they charged for it.

I used to see Dr's office charging for 3-4 well visits in an 8 week span...Ummmwhat the heck would you need that for? Turns out it was shots...

FM me if you need more help.

Unfortunatly there is not much the insurance companies can do to help. They pay based on what is billed and once the Well Child visits exceed the mandate, they need to pressure the Dr's to start billing correctly.

Re: Insurance not covering well visits...

My ped told me that Empire only covers like 8 or 6 well visits so we are spacing them farther apart than every month so they are all paid for.

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I would fight it with the dr's office - maybe they'll "settle" with you for a lesser amount, since you assumed they were covered and they never told you otherwise.

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Re: Insurance not covering well visits...

This happened to my girlfriend but only they waited months and billed her for all the shots she thought was covered at once. It was over $1,000. She was furious but had no choice but to pay it.

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THis happened to me...my ped wants the baby to come once a month for the first 7 months, then 9, 12, 15, 18, 24. My BCBS insurance only covers 7 well visits over 2 years- so I have been paying the "discounted" rate for the last few visits and have two more this year! I only found out, or thought of it when the same thing happened to my girlfriend! I talked to my dr about it, I actually picked him because his visits were more frequent because he only gives 2 shots per visit, so that was my choice. His way of working with me is giving me a discount when I have to pay for the remaining visits!

Re: Insurance not covering well visits...

Thanks, I am calling them about this.

They have only gone to the Dr this year for their one year check up, & their 18 month checkup. The 18th month one was what we are being billed for. These are the only times we have gottne shots, we go fro our well visits and shots at the same time, Hopefully something can be worked out becuase this is just nuts! I would be better off going in only when sick.

Re: Insurance not covering well visits...

I would def fight this. I have had well visits just about every month till month 4 then again at 6, 9 and 12 and my boys had their shots at those visits. I would totally question why a doctor is seeing a baby for a well visit and then make them come back for their shots. That makes no sense to me.

Re: Insurance not covering well visits...

Ali - I didn not have a well visit and then come back for the shots, I go at the same time, but apparently my insurance is not covering that.

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My insurance company is only covering $300 max for well baby.. which covers the first visit and shot... I have to pay for each visit and shot as he goes..