Ugh! My Insurance Doesn't over Well Baby Coverage past 1 Year!

Updated on January 06, 2011
K.M. asks from Carol Stream, IL
10 answers

I am really frustrated. I just found out ...(after making inquiries after receiving a $750 bill from my daughter's 12 month check-up!) that my insurance does not cover well baby coverage after 1 year. Ugh! We cannot afford to pay out of pocket for all these shots and doctors visits. We can maybe switch to my husband's insurance, but I'm not certain yet whether we can make that change or if we need to wait till an open enrollment period.

I have heard (but have no details) that there are programs in Illinois for the "underinsured" that help offer vaccinations. Can anyone offer any details? I'm at a loss about this and my husband advised me to "Go to your team of moms on the intranet." :) So, Team: Any advice?

Thanks!
K.

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D.N.

answers from Chicago on

Check with the Dupage County Health Dept. A friend of mine lives in Aurora and she was able to get discounted vacs for her kids (1 and 3) through the dept.

1 mom found this helpful
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S.B.

answers from Chicago on

The program you are referring to is All Kids in IL. You can go to their website at http://www.allkids.com to find out more. There are income limits if the child already has insurance, so you may not qualify based on your household income. Sorry to hear of your troubles, dealing with health insurance and all their "rules" can be very aggravating and overwhelming. Call you doctor's billing dept and work out a payment plan for the bill. Keep asking until you talk to someone who will work with you. The last thing you need is that bill going to collections while you try to work out your health insurance coverage, and doctors are notorious for sending them out fast. Good luck!

1 mom found this helpful

M.L.

answers from Houston on

It's odd that vaccines would be considered well baby and not preventive care.

Contact your county's health and human resources department. Ours in TX is only $10 per child for all yearly vaccines. Some only do this if you do not have insurance at all, and some still offer discounted rates even if you do have insurance or limited insurance. Just call and find out what your country offers. Some places have a huge wait, but others are really fast.

Really, I don't even mess with well checks. They aren't necessary, and I bring my kids to the Dr. if they are sick or I have concerns about their health anyways.

http://www.co.dupage.il.us/humanservices/generic.cfm?doc_...

B.S.

answers from Saginaw on

My insurance only covered preventative care for my kids up to $500 in a year after that it was all on me. So I had a similar time the after about 6 months. I found out you can go to the health department and get immunization shots cheaper if you do not have insurance or limited insurance. The only downside was that it was a long wait and I still had to go to the Dr's for the well check ups. Luckily my Dr allowed me to make payments and the well check visit itself wasn't that bad.

So I'd suggest start with your local health department and/or even talk with your pediatrician's office on what your best options are. After my second was born I found out that my Dr's office was allowed to use the health department shots after a deductible had been met. So that saved me the health department wait.

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J.W.

answers from Chicago on

I had a similar experience with my insurance, only it capped at $500 well baby visits. I looked into it, and the health dept. offered shots for $15 each. However, the new health laws changed a lot of things, and I just found out that all insurance is REQUIRED to cover immunizations at 100% after the 1st of 2011. I called my provider (BCBSIL) just to be sure, and it was! Of course, there are loopholes and I'm sure some insurers will find a way to deny but it's worth looking into just in case :) Good luck!

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J.C.

answers from Anchorage on

Here you can get kids shots at the health and human services office for free.

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J.G.

answers from Springfield on

Is your insurance refusing to pay for the 12 month check up? Because that's an annual checkup, and schools will require those.

Talk to your doctor's office to see if they have had this situation before and if they've worked with this insurance company. I live in Springfield and my husband works for the state, so they know our insurance very well! (Lot's of state workers in the capital city.) They might be able to help you speak to the right person.

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S.B.

answers from Redding on

Contact your local health department.
They do well baby exams and charge on a sliding scale or nothing at all, especially for vaccinations.
My kids got their check ups and immunizations through the health department and they were very nice and documented everything on the record.
I work at a hospital and have to have a pertussis booster. I am getting mine at the health department which will cost me basically nothing compared to a couple hundred dollars through my regular doctor.
It's worth a try. In California they have CHDP, The Child Health and Disability Prevention Program.
Contact your health department and ask if they have the same thing.
My kids were treated very, very well.

Best wishes.

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L.K.

answers from Austin on

I have never agreed with "well baby" visits. I have 3 children and have never done these check ups. The only time I take them in is if I have a concern or they are sick. I also researched vaccines a ton and selectively vaccinated the first two and decided not to vaccinate the 3rd at all. Well baby visits are just waste in my opinion.

Lisa

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M.G.

answers from Chicago on

I recommend going to the County Health Dept. My insurance caps at $500 a year for well baby care. Well, with twins, we blew through that in two visits. The county offers shots for $12.50 each. Yep! Very affordable. We just bring the printout to the pediatrician's office to update the records.

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