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January 2011 Moms
freeatlast2014
member
How would you feel about this? V.V.V. LONG!
freeatlast2014
member
I will try to keep this brief. We have been using the same pediatrician's office since JT was born. It came highly recommended by my neighbor and my aunt (who both have 3 kids). They have 3 offices, are open 7 days per week between the 3 (including holidays) and have a boatload of doctors. I almost never wait long and have pretty much loved every doctor we've seen.
1. JT was diagnosed with an ear infection back in March. She told me she saw red and fluid (but never said puss which is what would be the 3rd requirement for an actual infection). He was put on an antibiotic. I got the name of an ENT and made an appointment for the very next day. That next day he woke up with a crazy rash and the ENT told me JT didn't even have an ear infection. Rash could have been from the virus he was diagnosed with a few days prior (we had been to the pedi twice already that week) or it could have been from the antibiotic. We weren't sure but we stopped the antibiotic since there was no infection per the specialist.
2. In Jan we had his well visit scheduled. I thought he was sick so I figured I'd discuss that first and see what happened at the start of the appointment. Turned out it was an ear infection so he didn't get shots. They billed my insurance company for the well visit and the sick visit. I had to pay the $30 copay since it turned into a sick visit and I didn't get the benefit of no copay as I usually would have for a well visit.
3. In April JT had his 15 month well visit. I was billed $120 for this because I am only allowed 1 well visit per year after he turns 1. My insurance co. told me if they were to bill as a regular office visit I would pay the usual $30 copay. But since they bill as a well visit, it's $120. The office manager told me this is their policy and they won't change it for me. I'm now due with #2 so on top of ridiculously expensive insurance I would now have to pay $120 every time we walk in there for a well visit?! Also, if they just billed the sick visit instead of the well in Jan. then I wouldn't have been charged at all. Lastly, this will happen again at the 18m appointment.
That turned out to be really long. I'm just at a loss as to what to do here. I have an idea (I've put in 2 calls to one of the managing partners and am waiting for his call). Would you be upset? Does this all sound fine? Am I making too much of this? Would you leave over this? How would you handle this? HELP!!!
This discussion has been closed.
Re: How would you feel about this? V.V.V. LONG!
I think your insurance is the issue not the pediatricians office. I know it sucks but that's how they bill us too for things like that. Our insurance only has $20 copay for all well visits, whichever the pedi suggests we come in for.
I can't believe your insurance company only covers 1 well visit from 12-24 months, when a 12, 15, 18 and 24 month visits are pretty standard. I would discuss these issues with your provider.
Honestly though if you can't get it fixed, I don't think the 15 & 18 month visits are completely necessary. If you're worried about something call and schedule a sick visit. As far as your kids vaccines there should be plenty of health clinics in your area that offer free vaccines. Your pedi might even offer something where you just come in and get the shots from the nurses, as long as your not seeing a doctor they should only be able charge you for vaccines not any sort of well/sick visit.
I mean what do they do at your well visit: weight, height (all things you can check at home and refer to the CDC growth chart online) ask questions about developmental milestones (again things you can reference at multiple websites) and do a quick once over of lung/heart sounds, fontanels, throat and ears.
Maybe that sounds like awful advice to you, and you don't have to take it. And I probably feel more comfortable with those things because I have a stethoscope at home and know how to fully assess a child at any age. So take that with a grain of salt. But I still think the bottom line is that your insurance sucks, I'm sorry
I agree with ffejs that it's weird that your insurance doesn't cover more well visits, but they really shouldn't have charged for TWO appointments in ONE visit. That's BS and I would want them to change it. It's not making an exception, I can't see how they're allowed to bill for 2 visits at once. (Unless I misunderstood that part?) My ped also let's you go in just for vaccines if needed so that might end up being an option for you.
As far as I remember, there have been at least 3 times where you've been pretty disappointed with the actual medical advice you are receiving from the doctors at this practice, Is that right? (I'm sorry if I sound like a jerk, it's hard to remember who posted what.) If that's the case, I would definitely look into switching. (And I really remember you saying you were looking for someone else.)
It's great that you always have access to the practice, but I sort of think that's not something I would necessarily take into account in choosing a practice. You'd only go see a doctor on a holiday if there were an emergency, in which case you can go to the ER (and you'd probably prefer the ER).
FWIW, my ped is 35 min away and doesn't have such special hours but it's been fine so far.
It's good that you have a call in to the head doctor. Hopefully he/she will have something reassuring to say and you can figure out where you want to go from here.
I agree, your insurance sucks.
I'd switch doctors. It's great that other people like them, but you don't, and that's what's most important.
Thank you - you all raise really good points.
I have really overall been very happy there...except for 1 doctor that I saw twice but I can choose never to see her again.
I will double check with my insurance about the well visits 1 more time. If I owe them, I owe them. What can I do? If it's going to be like this at any office than I may as well stick there because there are enough capable doctors.
However, if one of these managing doctors doesn't return my call I will most certainly be going elsewhere. And yes, they billed for 2 visits in 1 with my insurance so I will bring up this and the misdiagnosis. Let's see how it goes.
Thanks ladies!
I have nothting new to ad but I would be very frustrated! I hope things work out and you get a call from the managing doctor. Your insurance sounds screwed up!