Well-child visit required by our insurance company??!

[T-man's Mama]

I received a call from the pediatric office today stating that our insurance company sent THEM a letter (not us!) requesting us to bring our DS into their office for a check-up. All I can think, is WTH?

DS is 17 months. We stopped well-baby visits early for a number of reasons, including the fact that we are not vaccinating (yet, maybe never) and it seemed like DS always got sick after one of these ridiculous visits that achieved nothing. We decided we would only take him in when we had a concern, or he was actually sick. Fortunately he is perfectly healthy and happy, and as a consequence, we haven't been in there in several months. I'm just really not too keen on visiting the ped where he will probably catch a bug (making all of our lives miserable for at least a week).

Has anyone else encountered this situation? I just can't figure out why our insurance company is playing big brother. I have no idea what would happen if we just ignored the call.

[Strong Mama]

Yes this is legit and a lot more insurance companies are doing this nowadays. If they are going to have to pay money for an illness, they want to make sure the $$ is as low as possible, so if you have preventitive care(ie well checks) and so call catch a disease early, the prognosis is better, therefore costing the company less $$ in the end. Most companies will refuse to carry you if they require the wellcheck and you do not comply. I am seeing this more and more with insurances.

[MCatLvrMom2A&X]

I would call them and make sure it is a requirement. Seems odd to me that they contacted the Dr. and not you directly.

I stopped taking my ds in for wbv when he was 4 months old and not a word was ever said.

[T-man's Mama]

So, I called the pediatrician's office today, and scheduled an 18-month wbv. I asked why it was required by our insurance, and the receptionist replied that it's actually the ped's office policy, and the insurance company just sends out 'reminders' (interesting, because nobody has ever mentioned scheduling a wbv to us, ever!). The receptionist seemed perplexed and annoyed that he's only been in there three times, and no wbv to date.

Well for one thing, the first few well-baby checkups were done at home with our midwife (we'd planned a homebirth). Secondly, we are not currently vaxing. Finally, we only took him in when there was an illness that we felt warranted it. So I consider it a success that he's been sick so rarely, but apparently they don't have similar standards for success.

I guess at his age, the frequency is now only every six months (until he turns two, I think, then it's yearly), so I think we can handle that.

[VillageMom6]

We received similar phone calls from our pediatrician's office. It seems our insurance company (BCBS) notified them that I needed to bring my children in for well checks. It's not a requirement in order to have BCBS but they were turning the screws on my ped's office.

Apparently BCBS keeps tabs on what percentage of children come in for well checks, how many go to the ER, etc... The doctors receive a score (and I believe even bonuses) if their numbers look good. If the doctor has a number of "non-compliant" families, his score goes down.

I felt really bad that my parenting decisions could be hurting our pediatrician's relationship with BCBS. He and I had a long talk about the value of well child visits, but I'm still not comfortable bringing a healthy baby to the doctor frequently. So I continue to decline.