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Because I don't vent here enough( :-) ), here's one about insurance

AgrippaRidesAgainAgrippaRidesAgain member
in D.C. Area Babies

Apparently, at some point after DS's 2 year checkup and DD's birth our pedi stopped carrying our insurance.  No one bothered to tell us, and now we've got gazillions of bills rolling in for her immunizations, the pedi hospital visit, the TWO times I went in about reflux issues, and the three well checks that we've had.  UUGH.  The pedi is still covered under the HMO version of CareFirst, but not the PPO, which is what we have. 

Something weird is also going on, because back in December, we got one of those "Explanation of Benefits" sheets that said that insurance was paying for the pedi's hospital visit, but today I got one saying that they weren't.  We have no f'ing clue what's going on.  The pedi's office claims that they are still under CareFirst's PPO, but CareFirst says that they aren't. 

Anyone know of any good small pediatricians in the Woodbridge area?  We'll be leaving this practice.  I need one by the beginning of March for DD's 4 month checkup...

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Re: Because I don't vent here enough( :-) ), here's one about insurance

  • KCH0906KCH0906
    Our practice isn't really small but we like it a lot - ALL Pediatrics. They have locations in Alexandria, Lorton, and Lake Ridge. The Lorton one is new and the Lake Ridge office was remodeled not too long ago. We love Dr. Caplan. Sorry to hear about all of this! I hate insurance paperwork :( Good luck!
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  • tracy042206tracy042206
    That really sucks and it seems odd to accept the HMO but not the PPO?  I always found the Carefirst PPO to be taken almost everywhere.  I always get a letter from a  doc when they are changing which insurance's they accept.  If you pedi is saying they accept but Carefirst is saying something different I would be so frustrated since you depend upon the actual dr office to tell you if they are accepting your insurance.
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  • AgrippaRidesAgainAgrippaRidesAgain member

    Well, we think it has all been mostly sorted out, but it's going to take a long time to fix.

    When the pediatrician registered for the PPO, they used the wrong provider number (how are we the only people that are having this problem?).  So, they are re-registering and resubmitting our paperwork.  They don't know how long it is going to take and can't guarantee that our account won't get sent to collections before then (WTF??!!) so we have to pay for everything now and then get reimbursed once it's fixed.

    So, I got Maggie's 4 month and Conrad's 3 year appointments with a different pediatrician.  It's a big practice, so I don't see us staying with them, but at least we have someone for the short term.  It'll be a pain to switch everything twice, but I don't have enough time to find someone and get an appointment before M needs her 4 month shots.

    Oh, and PP, thanks for the recommendation.  We actually were originally with ALL Pediatrics and I left for this new doctor b/c I didn't like anyone but Dr. Caplan.  It was too much of a pain to try and get appointments with just him.  We're trying out NOVA pediatrics for now and hoping for the best.

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