Pediatrician Costs

Updated on August 14, 2012
M.W. asks from Elkridge, MD
9 answers

Hi all.
Thinking about switching insurance plans, but am not sure I'm ready to get a plan with a deductible... Right now we have a $0 deductible plan but pay a high premium... we don't go to dr. that often, but kids need frequent "check ups" and shots for baby, etc. Which is better for long run?

Can anyone tell me their experience with deductibles and the pediatricians office? What can I expect to pay for my kids' visits (next checkups will be 9months for my son and 3 years for my daughter).

I just don't want to have to pay a HUGE out of pocket expense at the peds. office for checkup (with shots and all)-- even though I know it may save me $$ over the course of the year-- shelling out a ton of cash at one time may not be in the budget that month...!

Basically want to know estimated/average costs (out of pocket) for pediatrician visits for first year(including the necessary shots, etc).. so I can decide if its worth it to get a plan with a deductible..


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answers from Topeka on

Plans with a dedutible are better than having to pay 100% out of pocket.I know I been there and having to pay 100%.A typical visit is $79.00 well visits and shots are way more

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answers from Chicago on

We have a plan with a deductible and use the pre-tax medical account my husband has through work to pay for most of those expenses. It helps a lot because it saves us money by being pre-tax dollars and we don't have any big hits to the monthly budget. We get to set the amount we want taken out each year and set it higher the year we had our last baby and brought it back down the next year (because it is a use-it-or-lose-it account, we didn't want to oversave and then lose that money at the end of the year). If that kind of plan is not available to you, you could still set up your own medical account and put away a certain amount every month and hopefully that will cover all or most of the next bill. Then start saving again right away for the next appointment. Hope you find a solution that works for your family.

1 mom found this helpful


answers from San Francisco on

You need to check the individual plans, but with mine (Blue Cross) preventative care is free. So I get an annual ob/gyn, mamogram, and physical each year at no cost. I don't have any children on the plan so I'm not sure about well baby visits and vaccines. I pretty much bet they are free also. Check out their website - they have really good plans.

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answers from Norfolk on

Hi, M.:

Check out your local health department for vacinations,
immunizations, and shots.

See if that can help with costs.

Use Health Department and get a lower insurance

With insurance plans everyone is paying for those who are using
the plan.

Good luck with your decision making.
Just my ideas how to be conservative.



answers from Bloomington on

That's why you have to shop around. We have a $500 deductible per person, $1500 for family (we have 4 members).

Our co-pay is $30 a visit (which went up from $20 from 2 years ago).

ALL of our annual visits (adults) and well-child visits are covered, including vaccines. We don't pay anything at those visits. Not even a co-pay.

Now, if one of the girls gets ill, we pay $30 for a co-pay for the visit. If any labs are done, we pay 100% of it up to our $500 deductible, and then we pay 20% after that.

If you truly don't go often (we don't either), having a deductible isn't all that bad. Then you are paying for actual services instead of paying IN CASE you use the services.

Price out what you pay in premiums each month, and compare it to what you think you would pay with the same number of visits in a year.....keeping the well-child and annual visits free.

Hope this helps.



answers from New York on

I have had both employer provided as well as paying for our own health insurance. I have found that in general, the one with the lowest monthly premium is usually the best bet. When I got health insurance through an employer, I opted for the plan that paid 100% if I stayed in network, which is not an issue. I think it was a bit more but very worth it.



answers from Washington DC on

For us, it depended on the kid. We needed many Urgent Care visits for SS, which are $20 each under our plan. Regular kid well visits are no copay. Other visits that are not emergencies/after hours are $10 each. Find out what will and won't be covered - sometimes if you get shots at a nurse visit, or do regular health checks, those are not an extra fee. You can also look into a flex account so that you have the funds for the visits already saved.



answers from Denver on

your statement of benefits for the last ped visit will tell you how much a ped visit is. or just call them. also, just because you have a deductible or co-pay, check-ups and vaccinations could still be included - again you need to check with insurance company or on the benefits listing.
then, you need to estimate total out-of-pocket costs for each plan under two scenarios: a normal year and a horrid year. normal year is checkups and a couple of doctors visits plus premiums. horrid year is broken leg or something....a broken leg that needs pins can run $20k these days.
look at "max out-of-pocket" plus premiums for each plan.
I think you'll find its worth budgeting for the plan with the deductible. ours is 1/2 the monthly premium between the two (HMO vs high deductible) AND the maximum out of pocket plus premium is $3 k less per year for the high deductible plan. just make sure that ped, gyn, etc are "in-network" on the new plan.



answers from Seattle on

For just check-ups and office visits for minor illness it is about $100 a visit for us until we meet our deductible.
Beware however of emergencies: our urgent cate clinic charges a $300 facilities fee just for walking in the door, so if your child needs to be seen on a weekend things start adding up fast...and that isn't even the ER.
Personally I think if you have small children it is better to pay a bit more and get better coverage.
Good luck

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