Vaccines and Insurance Question

tashad18

Typically, how much do you pay with your insurance for LO's vaccinnes? 

We seem to be paying a lot ($320 after insurance for 6 month shots).  Our insurance feels like our pediatrician is charging too much.  We were charged a vaccine administration fee for each vaccine given, so it was like $22 per shot just for the service of giving the vaccine. So in addition to our well baby visit we were charged over $100 for the act of poking our child with a needle.  Then we had our co-pay for the vaccine itself. 

lefnc82

We pay nothing. I thought shots were part of the well baby visit, which my insurance covers completely.

PixiesDust

We haven't paid anything -- not even a copay.   We have really good insurance (i only paid $10 for my whole prenatal care and delivery) but $320 seems really ridiculous.  

chelseyestelle

We don't pay anything. It's part of the well baby visit for us.

huntjul

tashad18 said:

Typically, how much do you pay with your insurance for LO's vaccinnes? 

We seem to be paying a lot ($320 after insurance for 6 month shots).  Our insurance feels like our pediatrician is charging too much.  We were charged a vaccine administration fee for each vaccine given, so it was like $22 per shot just for the service of giving the vaccine. So in addition to our well baby visit we were charged over $100 for the act of poking our child with a needle.  Then we had our co-pay for the vaccine itself. 

Did the insurance give a reason for not paying, either on your benefit sheet or when you called to ask?  "Obamacare" I believe requires that all well baby visits and vaccines are covered 100%.  So I think it's worth looking into.  The catastrophic policy we have on Clara in the US (deductible is like $6k+) even covers these things 100%.  However, it doesn't cover them outside Ohio, so we pay out of pocket here. Thankfully the cost of our visit + vaccine today, out of pocket, was ~$100.

tashad18

I need to know what insurance you all have! We have ours through DH's employer and it seemed fine until this mess. 

skyla13

Yeah I would definitely keep looking into it! We are on an HSA as well, so we pay everything until our deductible is hit, which is several thousand dollars. However, all of L's vaccines have been covered 100% under the well visit. I really thought that was for everyone now...that sucks if it is not!!

ballygirl

Wow, that is a lot. I only pay a copay for my girls, $25 I think. I would talk to your pediatrician a billing department and see how they are coding it. I've gotten charged with all kinds of stupid shit in the past that was supposed to be covered all because the billing people didn't code it correctly. Like, they may not be coding it as a wellness visit which it is, and instead are coding it as some other kind of visit which isn't fully covered.

Check your insurance policy to see what it says about vaccine coverage and if it still seems like you are paying too much, start making some calls.

carawasa

Yea I think they passed a law and now it should be covered...I have Aetna and it's pretty shitty and we have no co pay.

MissLauraPants

Nothing over here either but I will say that my own personal insurance for me has opted out of the obamacare guidelines and no preventative woman care is covered so it's possible yiur insurance did too...

Lee81

I'm assuming the $320 was for all the six month shots, not each. Otherwise, yikes! My pedi charges $120 per vaccine, all of which my insurance is supposed to cover. With my plan, preventative care is covered at 100% up to $1000 per year.

taylormarie923

It has been included in our copays. We were with UHC and now with Humana.

Lee81

crunchymama11 said:

nothing. we have uhc.

i would deft protest a "vaccine administration fee"...wth is that???

I know, right? WTH else are you going to do with it? Give it yourself? That's a real douchecanoe maneuver. You know it's because the insurance called shenanigans on what they were trying to charge so they invented a fee so they could collect the difference from their patients.

mancila60

Nothing it's part of well baby

tashad18

Lee81 said:

nothing. we have uhc.

i would deft protest a "vaccine administration fee"...wth is that???

I know, right? WTH else are you going to do with it? Give it yourself? That's a real douchecanoe maneuver. You know it's because the insurance called shenanigans on what they were trying to charge so they invented a fee so they could collect the difference from their patients.

Yes, a fee of $22 per shot. So it was over $100 just for the act of poking him with a needle. I'm calling first thing Monday and having them explain to me each thing charged. We definitely will change if it continues to be like this.

emmylou78

My insurance is all screwy. I just chose my family doctor for her instead of a pediatrician. Well, I live in the Midwest, and most of the people in my town are on Medicaid. So much so, that now, since I DONT have Medicaid (but DO have insurance) my pcp can't give her the vaccines. He said he could if I had Medicaid. I have to go to the local nursing schools clinic to get them done. Honestly, it's $5 though, no matter how many shots she gets. Flat fee.

It's still crazy. Apparently it has to do with how it's billed. He said since they are multidimensional vials, he doesn't have enough non-Medicaid infants getting vaccinated to use up a whole vial, so he would have to eat the cost.

I insurance makes me head hurt!

muffyvonmuff

We have Aetna and haven't paid anything yet, including labor and delivery.  

jnsmith85

has615 said:

We have Aetna and haven't paid anything yet, including labor and delivery.  

Which Aetna plan do you have? We went with whichever plan was in the middle, and I paid probably around 5k already!!!!!

hlb622

We don't pay anything for vaccines; they're part of the well baby visit, which is $0 copay. All other visits are $30 each. I can relate to shit insurance but the admin fees would be enough to make me look into a different pedi.

Lee81

wedding06 said:

I would call the insurance co before the Dr. Yes an admin fee is ridiculous but I don't think it is out of the ordinary. What did they charge for the actual vaccine? My guess is they split up the charges and charge less for the vax and add on an admin fee. So the pp that said her vaxes are $120 each that has an admin fee built in. If it is anything like vet care the vax itself probably cost them $5-15.

Given the ACA I think this is more of an insurance battle.

I'm no expert but I think the doc is being shady by charging an admin fee. It's not like many people could choose to administer the shot themself. If I understand insurance correctly, the doc can charge whatever they want for services. Then the insurance will have a lesser rate that they negotiate to pay. So if my doc charges $120 for the shot, insurance can say "we'll pay $90. Take it or don't accept our insurance." If the doc wants to be able to see patients with that insurance provide, they accept the rate and they're out the $30 difference. This doctor seems to have found a way to charge the patient extra to make up for the difference between the insurance's payment and what their "real" charge is. Seems shady to me, but maybe it's a common practice that I've just never heard of.

Kathy1013

I normally only lurk, but since I work for UnitedHealth Care I figured I would answer. With any plan, your well visits should be $0 out of pocket. You need to make sure that your Dr is in network though, if he's not in network (which is what I suspect) then health insurance doesn't have to pay, or they can pay what they normally pay and then the Dr can bill you the rest.

NatesCupcake47

baconface said:

Nothing. I think they are considered part of a well baby visit. I assumed it was like that with all insurance... That sucks!

This is us too. 

[Deleted User]

The user and all related content has been deleted.

tashad18

@cdhaslag said:

I normally only lurk, but since I work for UnitedHealth Care I figured I would answer. With any plan, your well visits should be $0 out of pocket. You need to make sure that your Dr is in network though, if he's not in network (which is what I suspect) then health insurance doesn't have to pay, or they can pay what they normally pay and then the Dr can bill you the rest.

Agreed. It sounds like this pedi is out of network for your plan - most times offices bill the administration fee included with the vax fee which is why most people don't see it on their EOBs. Under the ACA all well visits should be 100% covered by insurance so I wouldn't pay a dime until it's sorted out. If the provider is OON though you'll have no choice but to pay the billed amount.

The pedi is in network.  I double checked on the website and with the insurance rep.  DH called a co-worker who has the same plan as us and he said they pay a $15 copay and that covers well baby visit and immunizations.  Needless to say, I will be calling the insurance company, our pedi's office, and HR (who handles DH"s insurance) tomorrow.