Do you have to pay a co-pay for your baby's well visits? For yours?
I just got a bill for DS and talked to the pedi and it's not a mistake. I have an EPO and maxed out my deductible by having him, so I only have to pay co-pays until January, but still, I thought well visits would still be taken car of since mine are.
We don't - our plan is ACA compliant. However, if they discover some kind of illness, they can submit that code too (i.e., if they find an EI, the well visit is covered, but they charge for a sick visit too).
This. For one of the visits (1 month maybe? When the well visits are is lost on me.) I had to pay a copay for one baby and not for the other baby. They had the exact SAME damn office visit. But they coded one baby's appointment as follow up for a weight gain concern (in addition to a well visit) and one baby's appointment as just a well visit. Because they weighed her? Oh wait, that's part of a well visit. Lame.
Also, it doesn't sound like this is the issue you're dealing with now, but you mentioned that you have met your deductible. But you could run into costs if you haven't met family and/or baby's deductible as well.
We don't currently, but when dd1 was a baby we had health insurance through DH's university. We had co pays for well checks but not for sick visits. It seemed very backwards to me!
Yes we pay a $20 copay, but I think after the first of the year we won't have to anymore. We also had to pay for flu shots which annoyed me. But I'm kind of confused by the whole thing. I read something about being grandfathered and that ends Jan 1 when our new plan year starts, but I don't get how that could be because this past year we got a new insurance provider with new plans, so how could something new be grandfathered? Insurance is weird.
Post by Stingyshark on Nov 29, 2014 7:29:08 GMT -5
We are also on an EPO. No copays.
Also. Just bc your pedi says it isn't a mistake, doesn't make it true. I would double check with your insurance and/or HR. I never trust the Dr office when it comes to my insurance benefits. Half the time people have zero clue what they are talking about.
Post by dragonfly08 on Nov 29, 2014 8:28:27 GMT -5
My kids can go to the ped. for any reason at no cost until they're 17 under our current policy. Specialist copay is $40 and ER or urgent care visits have a $50 copay.
DH and I have a $30 PCP copay, same specialist/ER/urgent care copays as the kids. My annual well woman visit with the GYN is covered 100%, however, so I just have her run my blood work and it becomes my annual physical as well.
No. 1 - we have a HDHP, which means no copays because insurance does not kick in until we meet our deductible. 2 - our plan provisions cover well visits at 100%. I would call the member services number on the back of your card to see what your plan provisions are regarding well visits and what is included in a well visit. For example, my insurance considers vaccines for the baby as well visits, but vaccines for H and I are not considered well visits.
No. 1 - we have a HDHP, which means no copays because insurance does not kick in until we meet our deductible. 2 - our plan provisions cover well visits at 100%. I would call the member services number on the back of your card to see what your plan provisions are regarding well visits and what is included in a well visit. For example, my insurance considers vaccines for the baby as well visits, but vaccines for H and I are not considered well visits.
It depends on whether a) the visit is coded as preventative care/a physical, and b) whether the vaccine is appropriate/recommended according to the CDC schedule. You can get vaccines outside of a well visit (so I can go to my PCP and get a recommended vaccine that is covered at 100%, but I go to my OB/GYN for my physical). So a pneumonia vaccine is not covered at 100% for me right now because I'm not old enough, and a specialty vaccine like yellow fever would not be covered because it's not on the list of recommended vaccines for everyone. But I can get a tetanus shot or a Tdap (either while pregnant or if I haven't had one) or a flu shot.
I can't bold on the app. But, yes, you should check how the visits are being coded. There are different codes for well visits vs. sick visits.
DH & I are required to get physicals every year & every year I have to tell our PCP office which codes to bill bc they always bill wrong.
No. 1 - we have a HDHP, which means no copays because insurance does not kick in until we meet our deductible. 2 - our plan provisions cover well visits at 100%. I would call the member services number on the back of your card to see what your plan provisions are regarding well visits and what is included in a well visit. For example, my insurance considers vaccines for the baby as well visits, but vaccines for H and I are not considered well visits.
It depends on whether a) the visit is coded as preventative care/a physical, and b) whether the vaccine is appropriate/recommended according to the CDC schedule. You can get vaccines outside of a well visit (so I can go to my PCP and get a recommended vaccine that is covered at 100%, but I go to my OB/GYN for my physical). So a pneumonia vaccine is not covered at 100% for me right now because I'm not old enough, and a specialty vaccine like yellow fever would not be covered because it's not on the list of recommended vaccines for everyone. But I can get a tetanus shot or a Tdap (either while pregnant or if I haven't had one) or a flu shot.
Flu shots and tdap were not well visits for me, even when the visit was coded well visit. This is why I say to call the member services number and ask specifically. Flu shots are definitely recommended for pregnant women, but it is not covered as a well visit for me and I had to pay for it as part of my deductible. It was covered for my son though.
Flu shots and tdap were not well visits for me, even when the visit was coded well visit. This is why I say to call the member services number and ask specifically. Flu shots are definitely recommended for pregnant women, but it is not covered as a well visit for me and I had to pay for it as part of my deductible. It was covered for my son though.
Flu, Tdap, etc. have been a nurse visit for DH or my non-pregnant self since ACA compliance (or covered at a Minute Clinic with an NP). It's not coded as a sick or a well visit. It's just coded as an influenza vaccine, not an exam.
As for whether vaccines are covered, that is dependent on your plan. If it is ACA-compliant, the following vaccines should be covered at 100% for adults (apparently I could get a chicken pox vaccine - I was mistaken). If your plan is not compliant, then none of this applies.
"Adults 19 years and older who are enrolled in new group or individual private health plans will be eligible to receive vaccines recommended by the ACIP prior to September 2009 without any cost-sharing requirements when provided by an in-network provider as of September 23, 2010.
Hepatitis A
Hepatitis B
Herpes Zoster
Quadrivalent Human Papillomavirus vaccine for females
LOL, dude I responded with my insurance info to say that op should call member services to see what is covered as well visits and what is not. I said this in both if my posts. I know what my insurance covers obviously, but she was unsure what her insurance covered. I do not need a lesson in medical billing as I've done it for 4 years and I clearly know my plan provisions. I was not complaining that these were not covered for us, because I expect them not to be.
It depends on whether a) the visit is coded as preventative care/a physical, and b) whether the vaccine is appropriate/recommended according to the CDC schedule. You can get vaccines outside of a well visit (so I can go to my PCP and get a recommended vaccine that is covered at 100%, but I go to my OB/GYN for my physical). So a pneumonia vaccine is not covered at 100% for me right now because I'm not old enough, and a specialty vaccine like yellow fever would not be covered because it's not on the list of recommended vaccines for everyone. But I can get a tetanus shot or a Tdap (either while pregnant or if I haven't had one) or a flu shot.
Flu shots and tdap were not well visits for me, even when the visit was coded well visit. This is why I say to call the member services number and ask specifically. Flu shots are definitely recommended for pregnant women, but it is not covered as a well visit for me and I had to pay for it as part of my deductible. It was covered for my son though.