Q about cost of immunizations

natgerber · August 2011

My LO had his two month shots and we recently received the bill and, after insurance, our part to pay is about $800. I'm wondering if the 4 month shots are considered 'boosters' and would be covered by the inital payment or if we should expect another huge bill after each shot appointment.

Of course, I could just call the docs office and ask, but I just thought I would put the question out here first.

Thanks

Sharon21 · August 2011

What insurance do you have? We have BCBS and only paid our normal office visit co-pay of $15 dollars when DD got her shots (both 2 months and 4 months). I would double check with your insurance and doctor's office and make sure something wasn't billed incorrectly, that seems like a lot.

ManiacMcGee · August 2011

I have no idea about the booster/shots question, but never call your doctor for questions about your insurance. Always call your insurance. Doctors offices make mistakes all the time.

p1nklemonade · August 2011

yikes. i would *assume* in this case that there's a mistake somewhere. call your insurance.

6fsn · August 2011

That is ridiculous. Double check your benefits and talk to the insurance company. I had this issue with #1 because the hospital bought the doc's office and it looked like we had gone to the hospital for his shots. I'd also talk to the HR rep in your office.

If that is a legit bill go to the local health dept. for the next set of shots.

katlizabeth · August 2011

6fsn:
That is ridiculous. Double check your benefits and talk to the insurance company. I had this issue with #1 because the hospital bought the doc's office and it looked like we had gone to the hospital for his shots. I'd also talk to the HR rep in your office.

If that is a legit bill go to the local health dept. for the next set of shots.

This, totally.

GHBEA · August 2011

Def call the insurance company. We got a bill for her 4m shots saying the shots weren't covered because the Dr wasn't on the same insurance. Well we always see the same Dr. any way we were shocked with $392 bill. We don't have to pay. I thought all immunizations were covered under insurance.

natgerber · August 2011

So my insurance (blue cross) said they only cover the shots once LO reaches his deductible ($3500). I asked them how they expect a healthy baby to spend $3500 in the first two months of his life. They had no answer to that! The health system is so f**ked in this country.

I will talk to my docs office tomorrow and see if that bill happens to cover the shots for 4 months and 6 months since they are shots for the same disease just broken up into multiple shots.

I had a look at the local health clinic websites and since I have insurance I can't get his shots done there

jteneback · August 2011

Yeah, if you have a high deductible plan you pay 100% until you hit the deductible. I have a $2,850 deductible and I paid it once for prenatal care and again for delivery. It sucks but it keeps premium costs down. And you know the max you are going to pay in a calendar year. I always assume I will hit the max.

6fsn · August 2011

I wouldn't give up just yet. Get ahold of your benefits package and double check. Most times the immunizations are not subject to the deductible. It's worth it to look at the book and talk to HR.

I would also call the health dept. They may not do it, but another county might. My sister has a high deductible insurance plan but can still go to the health dept.

If you do need to meet the deductible call the docs office. Tell them your situation and ask for a discount. They may reduce the charges they may not.

Sharon21 · August 2011

6fsn:
I wouldn't give up just yet. Get ahold of your benefits package and double check. Most times the immunizations are not subject to the deductible. It's worth it to look at the book and talk to HR.

I would also call the health dept. They may not do it, but another county might. My sister has a high deductible insurance plan but can still go to the health dept.

If you do need to meet the deductible call the docs office. Tell them your situation and ask for a discount. They may reduce the charges they may not.

This. It never hurts to ask.

atkinson4545 · August 2011

Do you happen to live in Texas? If so there is a program you can sign up for if your ins doesn't cover them for $14.86 each shot.

CutieBean79 · August 2011

Oh my, I would call and talk with someone. We didn't have insurance at the time of LO's 2 month shots (DH switched jobs) and we were told vaccines in Florida are $10 a piece for kids and that is what we paid. Now, I'm not sure about the 4 month shots being boosters and if this has any bearing on the cost, but it seems outrageous that vaccines or boosters would cost so much yet be required for many public schools. There is a disconnect there and I would research it more if I were you.

SouthFloridaMommy · August 2011

Even if your insurance doesn't cover them, that doesn't make sense. I got a bill for DD's 4 month visit and shots and the entire thing wasn't even $300, and I live in a high cost of living area. The shots were actually the cheap part considering the exam was $125 and some development screening was $50. Did you get the itemized bill?

MrsCarroll.6-10-07 · August 2011

Our shots are 100% covered along with well visits. I would be rasing helll if I got a bill for that much for shots!

I think you can ask to just pay the contract rate or something like that that makes you pay the lowest amount possible at the doctors office to save money.

RunningGal900 · August 2011

jteneback:
Yeah, if you have a high deductible plan you pay 100% until you hit the deductible. I have a $2,850 deductible and I paid it once for prenatal care and again for delivery. It sucks but it keeps premium costs down. And you know the max you are going to pay in a calendar year. I always assume I will hit the max.

Our Hugh deductible plan covers shots and well checks (as well as a pap and physical for me, and a physical for DH). Definitely worth checking into.

LoCarb · August 2011

I'm probably wrong b/c I don't follow politics but this is what I thought the Dr's office told me. B/c of the Obama Care ALL well visits are free including immunizations b/c they're part of preventive care. If you paid a co-pay the drs office will issue a refund at yr end.

Definitely follow up w/ your insurance to determine your coverage and benefits.

Gatorney · August 2011

kcarbonell:
I'm probably wrong b/c I don't follow politics but this is what I thought the Dr's office told me. B/c of the Obama Care ALL well visits are free including immunizations b/c they're part of preventive care. If you paid a co-pay the drs office will issue a refund at yr end.
Definitely follow up w/ your insurance to determine your coverage and benefits.

This. I would check with your doc's office and make sure they coded it as a "well baby visit". Even high deductible plans are supposed to be covering preventative care without co-pay or going toward the deductible. And like PPs said, if you will have to pay something, see what options you have with the health dept, just for the shots - I live in the Nashville TN area and they are free here.

PartiallySunny · August 2011

ManiacMcGee:

I have no idea about the booster/shots question, but never call your doctor for questions about your insurance. Always call your insurance. Doctors offices make mistakes all the time.

This.

iris427 · August 2011

Gatorney:
kcarbonell:
I'm probably wrong b/c I don't follow politics but this is what I thought the Dr's office told me. B/c of the Obama Care ALL well visits are free including immunizations b/c they're part of preventive care. If you paid a co-pay the drs office will issue a refund at yr end.
Definitely follow up w/ your insurance to determine your coverage and benefits.
This. I would check with your doc's office and make sure they coded it as a "well baby visit". Even high deductible plans are supposed to be covering preventative care without co-pay or going toward the deductible. And like PPs said, if you will have to pay something, see what options you have with the health dept, just for the shots - I live in the Nashville TN area and they are free here.

Here's what I found on Google about this:

Immunization Services for Children

Beginning September 23, 2010, children 0 through 18 years that are enrolled in new group or individual private health plans will be eligible to receive vaccines recommended by the ACIP prior to September 2009 without any cost-sharing requirements when provided by an in-network provider. Diphtheria, Tetanus, PertussisHaemophilus influenzae type bHepatitis AHepatitis BQuadrivalent Human Papillomavirus vaccine for femalesInactivated PoliovirusInfluenzaMeasles, Mumps, RubellaMeningococcalRotavirusVaricellahttps://www.healthcare.gov/news/factsheets/affordable_care_act_immunization.html

OP, $800 for routine childhood shots is outrageous. Make some phone calls to see if things were billed correctly. And check with your county health department--mine does childhood vaccines for free.

JenWen3 · August 2011

We pay nothing for the shots or even the visits - not even a co-pay. Well baby care is 100% covered under my plan.

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