Pediatrician's office told me my son's doctor visit wasn't covered y my private insurance.

[Ilsa]

It was a wellness checkup for discussion of his ADD, evaluating his growth, etc, and discussing renewal of his prescription. When I went to checkout, the office clerk told me that their day-before-check with my insurance company (UHC) had resulted in them telling her that a Well-Child Visit wasn't covered. We're considering filing it under another code for payment if they won't honor Well Child visits.

[DebbieCDC]

1. What imbeciles

Doesn't it occur to these companies that WELLNESS checks prevent SICKNESS????

[Selatius]

7. They're thinking short-term profits, not long-term sustainability.

It is a problem that currently plagues the business world in general.

[aquart]

2. Have you told your Congressman and your state reps?

Because they need to hear and feel fear.

[Kittycat]

3. We had the same thing happen last month, also UHC

They had to refile it under a different code. My son had his regular well baby back in January, and he's only allotted one, despite all his health issues. His new school insisted that they have a recent medical review on file, complete with scripts, procedures, etc. The claim was first denied, then they recoded it and it went through. Total PITA though.

[tnlefty]

4. Well baby/child visits were never covered for us, and

those amounts never applied to the deductible as they weren't covered.

A few years ago when the cost was around $1,000.00 for physicals, we stopped taking them.

[sharesunited]

5. United Healthcare is publicly traded under the symbol UNH.

Everybody buy one share, take it in certificate form, and meet back here for some coordinated shareholder action.

Oh yes, it can be much more of a hassle for them to deal with holders of one share than it is to deal with holders of thousands of shares.

[WillowTree]

6. "We're considering filing it under another code ,,,,,,,"

You're willing to take that risk? Because that's insurance fraud and you can count on the fact that they'll have a record of the fact that that doctor's office called on your behalf and were told that the planned service(s) weren't covered by your plan. If a claim comes in for services that are consistent with a well child visit with a different ICD9 code, they probably won't prosecute or even cancel you over something that small, but more than likely your account will be flagged for "enhanced scrutiny" (ie. delays, requests for additional documentation etc.) for anything else you submit for a good long time.

Oh, and what if they request medical records from your doctor to verify the claim as submitted? That's a real possibility. Would your doctor really be willing to risk his or her license by falsifying your son's chart for you? I hope not. I for one wouldn't trust my child's health care to someone that reckless.

It's just not a good idea. Two wrongs, as they say, do not a right make. JMHO.

[elleng]

9. Not falsifying,

but stating proper code for service provided.

No reason to fear-monger here.

[WillowTree]

10. Whatever.

Perhaps I'm just naive, but I'm frequently amazed at how many people will almost proudly justify that they're not above lying so long as they think it suits their purpose.

Good luck to you.

[elleng]

11. AGAIN,

it is not lying to ask that the service be properly characterized as 'med check' when that's what it is.

I don't think you're naive, I think you know what you're saying. I don't know why you would accuse people you don't know of legal and/or moral wrongdoing.

[WillowTree]

12. AGAIN,

good luck to you.

[elleng]

13. Thanks,

my Doc and I are fine.

I hope the OP here, and her family, are also.

[Ilsa]

14. Actually, they probably should have filed it under another code to begin with.

The purpose of the exam was to determine if he's grown enough to warrant a higher dosage of an ADD med (which typically cause a small level of anorexia). A general physical went with it, but I wouldn't have taken him in to see the doc if we didn't need his script reviewed. My kids are rarely ill enough to see a doctor.

We're already under scrutiny. My oldest is very autistic and they refused to pay his speech therapy (you have to be injured or have a stroke to qualify for sp tx). So my husband is so valuable to his company that they included a special rider with the policy to cover most of the therapy with some limitations (better than nothing, and probably paid indirectly by the company). They still took two fucking years to pay his therapist's claims, even with countless phone calls wherein they agreed it is a specially covered benefit. My son's therapist finally dropped us. Also, his psychiatrist has to code him ADHD to get coverage for him. Insurance cos won't typically pay anything directly related to autism. But he clearly has ADHD, so they have to pay for that.

But thanks for your comments. As a nurse, I know it is a touchy subject.

[elleng]

8. 'Smart' doc offices/administrators know a lot about 'codes,'

and do a good job making them work to benefit patients. We all get (should get) 1 or 2 'well' visits per year. Medication check-ups should be covered.

Good luck.

[NotThisTime]

15. BCBS has now turned down the only treatment that allows my daughter to move her neck...

They paid once for the trial, it was a success, now her neck is seizing back up and they won't pay again... think about never being able to move your neck out of a fixed position looking straight ahead..... Now I either pay 2500 four times a year out of pocket or I let her go like this...

[Dappleganger]

16. BCBS is the Devil