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Does anyone have alot of knowledge about health insurance?

Forum: 2011 Playroom


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  • 2 Post By kazarmo

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August 20th, 2012, 02:24 PM
amrose's Avatar loves her little monkey!
Join Date: Apr 2011
Location: West Texas
Posts: 1,313
My insurance only covers $500/year towards well baby checks for Hunter. His pedi is giving us the $5 shots but they are still billing the insurance company knowing that they will not pay them anything, so we are having to pay huge amounts (over $600.00/ visit) at a time. I called today to schedule Hunter's 9 month appt and asked them if they could just not charge the insurance company and just give us the 40% discount they have mentioned to us before and the lady told me that it would be insurance fraud!! Is this true?

I have checked into getting medicaid for Hunter as a secondary insurance, but we don't qualify and I'm at a complete loss as to what to do. We can NOT continue to pay these outrageous bills everytime we take Hunter to the doctor.
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August 20th, 2012, 04:06 PM
Loves Kate!
Join Date: Nov 2010
Posts: 652
I don't know anything about insurance so sorry I can't help but that sounds crazy. I don't know why they can't just let you pay. I also don't understand why they don't cover well baby visits. I've never heard of that.

Born 11/19/11
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August 20th, 2012, 05:39 PM
I love my family!!!
Join Date: Jun 2011
Location: Texas
Posts: 743
My dad sells health insurance and I used to work for him, so I know a little bit. I am shocked that your policy only covers $500 in well baby checks. Like, 90% of most policies cover them at 100%. Have you checked your EOBs (explanation of benefits--the form that comes in the mail after a claim to detail what was paid/not paid, etc.) to see how the doctor is billing them? Maybe they're billing them as sick instead of well??
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August 21st, 2012, 07:17 AM
amrose's Avatar loves her little monkey!
Join Date: Apr 2011
Location: West Texas
Posts: 1,313
I have kept and checked all of the eob's, called the insurance company regarding them got nowhere) and also spoke with a cousin of dh that works at the hospital where I had Hunter. He has been dealing with insurance companies on the billing side for many years and he said that he has seen several insurance companies that only pay $500/ year. I talked to my sister and she said her insurance is the same way for her children.
I really need to find another option, but I'm not even sure where to start!!
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August 22nd, 2012, 06:08 AM
kazarmo's Avatar Mega Super Mommy
Join Date: May 2011
Posts: 1,354
What about just getting immunizations at the health department? I know they still charge but it's usually a lot cheaper then what the doctors would charge.

dd15 born weighing 6 pds 2 ounces, 19 inches. 12-3-96
dd9 months born weighing 6 pds 5 ounces, 19 1/2 inches. 12-22-2011
Expecting baby #3 ANOTHER GIRL!!!!!!! woot woot

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August 22nd, 2012, 07:50 AM
amrose's Avatar loves her little monkey!
Join Date: Apr 2011
Location: West Texas
Posts: 1,313
I'll have to check into that. Thanks Brooke.
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August 24th, 2012, 06:41 AM
sugarloafbaby's Avatar Mega Super Mommy
Join Date: Oct 2009
Location: Ohio
Posts: 3,094
I second the health dept - ours charges a $16 administration fee and that's it. That's ridiculous you are paying hundreds for what should be close to free/very cheap.
Mommy to 2 girls , 6/26/10 & 12/31/11

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