Well Baby Visits

I work in a doctor's office and that would be considered insurance fraud. If the baby is sick, yes, but if only come in for a well baby check up they can't.

My mom actually works in insurance as a claims something or other. Her job is to review medical claims to make sure they are legit for insurance to pay. I know she has had to turn many drs in for fraud for trying to slip things by the insurance companies. I can also tell you as a parent of a child who actually does go to the dr a lot for being sick, insurance does watch. Our insurance company assigned my son a case manager and nurse to help monitor his health, likely because they had so many claims on him within a short period of time.

I totally understand your side... at my previous job, I helped hospitalized patients apply for Medicaid benefits when they either had no or limited insurance (as your appears to be). I did this for 6 years. I know Medicaid has a negative stigma attached to it, but the benefits are actually really good (and cover well child check ups and TONS of drs will accept Medicaid). The programs are income based... no cost for those who make little income to co-pay levels for those who make decent income. Depending on your family size and household income, your child(ren) may qualify for secondary Medicaid coverage that could pay whatever your primary (spouse's insurance) doesn't cover.

Best of luck!

I wouldn't even ask the doctor. That is considered fraud and they cannot do it. You might ask for a discount if you pay at time of service. I worked for a pediatrician and if someone asked when they made the appt to pay at time of service we would give them a discount. That way we had the money for the service and did not have to send statements.

I would try and talk to your doctor about getting a discount on well baby visits, and/or coinside them with sick visits. I would be careful asking your doctor to code them differently, because that is insurance fraud. Insurance fraud not only voids your policy, so that the company will not pay for anything and maybe even make you back pay for all appts your child has ever had, but it is also a federal offense for both you and the doctor.

You could try but most doctors might do it a few times, but not to much because that is insurance fraud. If the child is sick they have to put a code as to what was wrong. I work with insurance and they would questions all the "sick visits." Talk to your doctor and explain to him/her that insurance does not cover well baby visits and they might not charge as much. There are other places to take your baby for well baby visits. Depending on your childs age, they might not need as many well visits checkups as you think.

Lol our insurance covers both visits but I can assure you that someone at Blue Cross is questioning if our doc is coding things wrong- we've had 12 sick visits and 2 trips to the GI specialist. Haha.

I wouldn't be ashamed in asking them to code differently at all. You've gotta get your baby to a doctor and every child needs to be seen by an actual doctor, not just someone at the county health dept. It's not like they have well visits every week either, so I don't think insurance would question it much. Unless they're actually paying attention to the age of the baby and know that a well check comes then...

Yes it is okay and if they say no do not feel embarrased. I do it each and every time and my doctor does what he can. At least he gets paid instead of me paying in tiny installments. You can also do the well baby check ups at the health dept as they have certain days that they do those. You can call and ask when they do it, often they are mobile clinics. I liked the well baby check ups however I found if my child had an issue then I would have to start over again with the DR and that could mean drawing more blood. It became an issue for me so I quit going. Also my child had to have a major surgery and the hospital wrote off 75% of the cost as they considered us underinsured - my husband makes a very decent salary. Always ask and always apply if the need arises even if you make decent money. Good luck.

I think if you explain it to your pediatrician, they will be cool with that. You will just have to remind them each time you go.

My husband is a dentist, and I know if he intentionaly used the wrong codes, he could lose his license. You would be asking your health care provider to put his/her livelihood in jeopardy. I guess you can always ask, but that is really putting your doc on the spot.

Are either of you employed at a place that has a FLEX or CAFETERIA plan...these are wonderful for handling medical expenses not covered by insurance, not to mention that they reduce your taxable income and you pay less taxes come April 15th.

Best of luck...this is why we need our health care revamped in this country! Americans need to wake up to this. You shouldn't have to be put through this because some insurance company wants to make extra profits.