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Well child visit? Nope, just vaccines... (vent)

post #1 of 6
Thread Starter 
At least that's the impression I get from our health insurance because that's all our insurance will pay for. We don't vax and don't generally do well child visits. However, we do like to take the kinds in once a year for a well child visit sort of as a CYA. This is our second year with this h/i through my dh's employer and the first time we've even come close to having the money to pay for our copay, deductible, and co-insurance for the visits for all three children. I called the h/i to verify coverage levels and was told that they'll only pay for well child visits for children 4 yo and younger. They'll cover vaccines in full until 4yo and then any other vaccines after that according to copay, co-insurance and deductible.

They'll pay for a well visit for adults, but if you're on the plan and between the ages of 5-18 they'll only pay for vaccines. I guess from now on I don't have to worry about doing well child visits for my kids once their older than 4 yo. If asked I'll answer..."My health insurance doesn't pay for it" and leave it at that.
post #2 of 6
It seems really odd that your insurance wouldn't pay for a check up.
post #3 of 6
that seems a little odd, perhaps its in the wording. For instance our insurance only pays for *well child* or *well baby* appts until age 5. Annual physicals are covered from age 5 and on so if I asked my H/I if they covered a 6 yr old well child appt the answer would be no but if I said annual physical it would be yes...perhaps its in the wording?
post #4 of 6
Thread Starter 
I thought it was odd as well. I was specific - they said they would just cover visits to the doctor if ds was ill. Well...that and vaccines until he was six for free. DH is going to ask his union rep to see if they understood anything differently.
post #5 of 6
I hate health insurance!!!

OK tell me if this makes any sense, we received a bill for them to administer a vax (we don't vax now but did get DS part of the dtap series when he was younger). Vaxes are covered UNLESS you get a different brand than the ones the doctor provides, but we had already paid for the vax vial itself, they were actually charging us extra just because we deviated from their set schedule. There is no administration fee if you get their 7 shots but if you get just one (and it's one you bought yourself) then it magically costs $$ to stick him with the needle!

Fast forward & DS had to have some routine blood work. Two weeks later we get a huge bill in the mail, turns out they only cover bloodwork to diagnose a specific condition??? Something like that, I don't really get it. So you could have WBV's as long as they didn't run any tests... Doesn't make sense since things like Lead are required by the state...

Then we switched jobs (and therefore insurances) and now we pay for pretty much everything -- huge copays & deductibles -- and I think they only cover well child visits until age 4 or 5 or something??? I don't know, all I know is I have $100's of medical bills...
post #6 of 6
seems really NORMAL to me!!! just like our insurance!!!!!

They wouldn't pay for a well visit for our than 1 year old (birthday was in Jan - winter-snowy- dr. going away for the month) so the 31st of Dec we made our apt.- NO PAY AT ALL- too many visits in that year for them- REGARDLESS that the office fought on our behalf with the insurance company and said this was the one year visit- all really came down to x # of visits in a year and it was ONE day prior to the "new" year--- and our company DOES pay for "well-visits" not too many - but the DO NOT pay for vacs!!! go figure
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