Paying out of pocket to not vaccinate? - Mothering Forums

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#1 of 29 Old 12-09-2008, 04:48 PM - Thread Starter
 
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So I've been in the process of switching doctors because the only ped in my area who will see non vaccinated children isn't making me very happy due to four hour waits, differences in opinion, etc. So I'm opting to go back to another family doctor an hour away instead. I was surprised when I made an appt for my son to hear them tell me that there is a $200 out of pocket fee for an "alternative vaccination schedule" outside of the CDC guidelines which isn't covered by insurance. WTF?! I asked her what if you don't vaccinate at all and that really threw her for a loop. She didn't know the answer to that. I guess I'll find out when I take my son in for unrelated issues.

Has anybody else heard of this happening?
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#2 of 29 Old 12-09-2008, 04:52 PM
 
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wait .. they charge you not to vaccinate? wow.... is it a one time fee? how can they charge you not to do something? i just get the feeling this is spiraling out of control. this is ridiculous
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#3 of 29 Old 12-09-2008, 04:55 PM
 
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That's loopy :
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#4 of 29 Old 12-09-2008, 04:56 PM
 
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Originally Posted by pixiewytch View Post
So I've been in the process of switching doctors because the only ped in my area who will see non vaccinated children isn't making me very happy due to four hour waits, differences in opinion, etc. So I'm opting to go back to another family doctor an hour away instead. I was surprised when I made an appt for my son to hear them tell me that there is a $200 out of pocket fee for an "alternative vaccination schedule" outside of the CDC guidelines which isn't covered by insurance. WTF?! I asked her what if you don't vaccinate at all and that really threw her for a loop. She didn't know the answer to that. I guess I'll find out when I take my son in for unrelated issues.

Has anybody else heard of this happening?

I think I know what she means....


Insurance pays for WBV at 2, 4, 6 9 12 and 15 months (these cooincide with vaxes for a reason). People doing a selective or alternative schedule will be being seen more often for "WBV's" so insurance will not pay for these and you end up paying out of pocket. This is the only thing I've heard of. If it is an extra fee as "punishment" for not following the CDC schedule it is a stupid policy and I would run away from that practice as fast as you can!!

If the people let government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as are the souls of those who live under tyranny." Thomas Jefferson.

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#5 of 29 Old 12-09-2008, 04:58 PM
 
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Insane


My question to the PP is why would you think that someone on a selective or alternative schedule would be seen more often?
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#6 of 29 Old 12-09-2008, 04:59 PM - Thread Starter
 
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Okay, that makes more sense..which won't apply to us anyway since we don't vaccinate.

I don't doubt the practice because I've been there before and I know they are a sound place. There must be some logical reason why they are doing it. They are even listed on Dr. Sears's website as recommended physicians. I had just never heard of it before and thought it was a bit crazy.
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#7 of 29 Old 12-09-2008, 05:01 PM
 
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What is the code in your insurance for such a charge? That does not make sense. Looks like you are being singled out and harassed.

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#8 of 29 Old 12-09-2008, 05:15 PM
 
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My 2 cents.. since they aren't making money off all the vaccines, they are making it up in this stupid "fee" that sounds like BS to me.
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#9 of 29 Old 12-09-2008, 05:18 PM
 
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Originally Posted by Arduinna View Post
Insane


My question to the PP is why would you think that someone on a selective or alternative schedule would be seen more often?
What she's saying is that you'll go in for those WBV, for the visit....but will then hve to make another appointment for the shots. ie if you're spacing them out more..or separating the M from the other M and the R (), you'd need 3 visits for that instead of the one.

Either way, I call BS on this practice's practices.

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#10 of 29 Old 12-09-2008, 05:40 PM
 
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Originally Posted by Arduinna View Post
Insane


My question to the PP is why would you think that someone on a selective or alternative schedule would be seen more often?

Lets say you want to space out or get the shots singlely...you will end up making more trips to the office to accomadate that schedule which insurance will not pay for. I have a friend who is doing an alternative schedule and she spaces things out so not to give too many shots during 1 visit....thus she ends up going more frequently then is allowed by most (I suppose not all...but the big one) insurances for WBV's.

Opps sorry didn't see cookie's response...yes that is exactly what I was saying Thanks!

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#11 of 29 Old 12-09-2008, 06:12 PM
 
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Insurance practices are more stupid than I thought if that's how they work.
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#12 of 29 Old 12-09-2008, 06:16 PM
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This is insanity! I would never pay that. I have heard of this though.
http://sayingnotovaccines.blogspot.c...n-bullies.html
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#13 of 29 Old 12-09-2008, 06:22 PM
 
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When DH and I were considering a delayed/alternative schedule for DD, and when I brought this possibility up at our peds office they pretty much told me the same thing. They never gave me a dollar amount, just that I would be paying out of pocket for the extra visits and that it most likely wouldn't be covered by insurance. I think it's crazy, the "appt" would take all of 2 min. for a nurse to come in and administer the shot.
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#14 of 29 Old 12-09-2008, 06:22 PM
 
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That's fine. Now everyone will run to the doctors that actually don't want to vaccinate and instead of making $20 extra from these families, they'll make a lot less.
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#15 of 29 Old 12-09-2008, 06:28 PM
 
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That's fine. Now everyone will run to the doctors that actually don't want to vaccinate and instead of making $20 extra from these families, they'll make a lot less.


also if your spacing out vax instead of going in for a bunch of extra visits couldn't you just space them realllyyyy far and get one per visit?
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#16 of 29 Old 12-09-2008, 08:25 PM
 
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Well if you aren't vaxing on the typical schedule you won't need all the normal visits, since they are primarily for vax anyway. Personally we never went to the Dr unless we were sick but we don't vax at all.
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#17 of 29 Old 12-09-2008, 08:44 PM
 
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Is this like they are charging a retainer fee or something?

Totally ludicrous. I wonder is some doctors that are open to (but not totally supportive of) alternative/selective/delayed/no-vaxing are savvy that these types of families are being booted from most other practices and are capitalizing on that?

I'm pretty sure insurance companies will not pay for services that are NOT rendered, and placing a premium on well visits on families that aren't vaxing on schedule is discrimination. I'm pretty sure it's against the law to do that.
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#18 of 29 Old 12-09-2008, 08:46 PM - Thread Starter
 
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That's fine. Now everyone will run to the doctors that actually don't want to vaccinate and instead of making $20 extra from these families, they'll make a lot less.
Well, considering that I can only find two doctors within an hour's drive that will see patients who don't vaccinate, I don't see where this will hurt anybody but the families who need a physician.

And btw as I mentioned already this ped is actually non vax friendly. She is on Dr. Sears list and this is why I'm driving an hour to see her. I guess that's why I figure the fee must be something to do with insurance and not that she is trying to harrass her patients. I don't know, it's confusing but like I also said, we don't vaccinate at all so it won't really apply to us I guess.
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#19 of 29 Old 12-10-2008, 03:46 PM
 
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We go to DO's in Lutz and have been very happy with them. No problems with us not vaxing, etc. I know that's a drive for you, but they really are nice.


What a crock of bs to charge patients for not following party line. This kind of crap really makes me angry. Just one more reason we basically NEVER go to the dr.

Hope you can find someone good, who doesn't rip you off!

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#20 of 29 Old 12-11-2008, 11:50 AM - Thread Starter
 
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This doctor is in Lutz actually. I called several DO's around here btw and they were all very snotty to me about not vaccinating.
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#21 of 29 Old 12-11-2008, 01:26 PM
 
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Do you need to see the doctor often? Even though we have a ND in mind, we haven't actually gone to her and I'm honestly not at all worried about all the WBVs.

And $200 extra is a ridiculous amount of money to pay regardless of the purpose of the visit anyway.
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#22 of 29 Old 12-11-2008, 01:32 PM
 
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When we selectively vaxed, they didn't charge us for the vax visits at all, since all it required was a nurse jabbing them with a needle and not an actual doctor. Just like they didn't charge for weight checks. Maybe I'm just lucky with my doc though.

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#23 of 29 Old 12-11-2008, 01:57 PM
 
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Perhaps the extra cost is to see a doctor instead of just a nurse then?
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#24 of 29 Old 12-12-2008, 03:00 PM
 
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No. I wouldn't advise going to a 'care' provider who discriminates (financially, even...freakin' crazy...aren't there laws against this sort of thing? Talk about coercion!) against non-vaxing clientele, either.
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#25 of 29 Old 12-13-2008, 05:04 AM
 
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What I want to know is the answer to your orginal question when you called...what about non-vax altogether? While I can sort of understand the fee for possible multiple visits (although if you didn't rack up extra visits would the fee still exist?) it would blow my mind if it was the same for you. I will not pay my dr to NOT buy shots and NOT administer them anymore money than I would pay to have her do it.
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#26 of 29 Old 12-17-2008, 06:27 PM
 
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No, that's not true at all. You should report them to your insurance company, because that's fraud. The insurance company pays them to administer the vaccines - whatever vaccines you choose that are covered at any age, as long as they are covered at that age. For instance, Prevnar might not be covered for a 7-year-old, but it would be covered for an 9-month-old, even though it's recommended you give it at 2,4,6 and 12 (or 18 or whatever that last one is).

It really is fraud for a doctor to try to charge you for that. They sign agreements with the insurance companies on what they can and cannot charge. For instance, almost every insurance company has a rule that they can't except payment from the company and then turn around and charge you on top of that (except for copays and stuff that is specifically described in YOUR insurance policy). If your policy doesn't say you have to pay it, then it's fraud for them to try to charge you that, because they're violating an agreement they made with your insurance company not to scam their clients.

You REALLY need to report that to your insurance company. A doctor who accepts your insurance is not EVER allowed to charge you for anything that's not laid out in your policy, if that's the type of agreement they have. If something isn't covered, your policy will say so and your doctor can then charge you whatever they want for it. Vaccines are covered. They are not covered on any particular schedule. They're just covered. The doctor is trying to circumvent the agreement they made with the insurance companies. Basically, the insurance company says, "We'll reimburse you X amount for Prevnar, X amount for Hib, X for DTaP, etc. That's ALL you can charge for those vaccines, aside from co-pays. You can't collect X from us, then charge our patients Y on top of that." So what the doctor is trying to do, is charge you Y, without saying, "We're charging you Y on top of the amount your insurance pays," since doing so would be a violation of the agreement they have with your insurance company. It's fraud - they're trying to get paid by both you AND the insurance company. They just have to phrase it carefully, so as (hopefully) not to get caught. It's still illegal, so you should report them or threaten to do so. This is why some doctors don't accept insurance at all (reimbursement rates are too low and inability to collect from patients makes it not worthwhile).

At least, it's illegal if they have that sort of agreement with your insurance company, which they probably do as it's relatively standard. Read your policy. Most of them will specifically say that a doctor can't charge you more than what they've agreed to accept from the insurance company. If there are exceptions to that rule (there sometimes are) then that will also be explained in the policy. Please don't just pay it without verifying that your insurance company allows this. Your insurance company probably does not allow this.
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#27 of 29 Old 12-17-2008, 06:53 PM
 
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Okay, here's a good description:

http://www.ehealthinsurance.com/ehi/...1-18;entryId=1


Quote:
Allowable Charge -also referred to as the Allowed Amount, Approved Charge or Maximum Allowable. See also, Usual, Customary and Reasonable Charge. This is the dollar amount typically considered payment-in-full by an insurance company and an associated network of healthcare providers. The Allowable Charge is typically a discounted rate rather than the actual charge. It may be helpful to consider an example: You have just visited your doctor for an earache. The total charge for the visit comes to $100. If the doctor is a member of your health insurance company's network of providers, he or she may be required to accept $80 as payment in full for the visit - this is the Allowable Charge. Your health insurance company will pay all or a portion of the remaining $80, minus any co-payment or deductible that you may owe. The remaining $20 is considered provider write-off. You cannot be billed for this provider write-off. If, however, the doctor you visit is not a network provider then you may be held responsible for everything that your health insurance company will not pay, up to the full charge of $100.
Most insurance companies have a maximum allowable charge for practically everything, and in-network providers are required to accept it as part of their agreement with the insurance companies. If this is the agreement your doctor has with the insurance company (and it almost certainly is) then they're trying to get around the rules by making up extra charges, so they can't be accused of charging you for the write-off. But that's also a violation of the agreement they have with your insurance company, because they can't just make up crap to charge you.
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#28 of 29 Old 12-24-2008, 12:31 AM
 
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that doesn't sound right at all. if a person were to follow an alternative schedule.. they would be paying with the extra co pay( if they were splitting vax's instead of doing the full dose of toxins).

I am sure we all know that peds make a huge part of their money from Vax's but this is just ridiculous;
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#29 of 29 Old 12-24-2008, 01:27 AM
 
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Please don't just pay it without verifying that your insurance company allows this. Your insurance company probably does not allow this.
I agree with this...I saw on our statements that the ped was charging the insurance company for vaccinations, and I just called the ins co and said that we didn't vaccinate on that date (I never mentioned that we don't vax) and that they might discuss it with the ped office. It's never been charged again.

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