Questions about Pediatrician and Billing...normal to pay copays?

I just have a question because this bothers me about my pediatrician's office enough that I want to switch peduatricians, but I'm not sure if this is how all doctors do it. My insurance covers wellness and preventative care 100%. So I was irritated when my twins on their wellness visit got their TB test, and I was told to come back in 2 days for the reading to check their arm and told I have to pay a copay for each kid for that. For the check up that takes 10 seconds to look at their arm. And when I asked if a nurse could do it, they said no.

Also when they get their flu shots which are 100% covered, I still have to pay a copay for all 3 kids because they bill for a physician visit with it for each kid. This is just really starting to annoy me because their dr visits add up, and we have specialist visits and we had a hospital bill. So is it normal they are charging me like this, or should I change doctors?

Questions about Pediatrician and Billing...normal to pay copays?

I have to pay a co-pay whenever I take my DD in that is not for a well visit or a sick visit. So if I take her in for just a shot, I have to pay.

Re: Questions about Pediatrician and Billing...normal to pay copays?

I would ask your insurance co. I have Fidelis Care Child Health Plus for DS and I haven't had to pay co-pays for any visit. But when we were on United Healthcare Oxford we had to pay a co-pay for ever little visit except wellness ones.

So it may not be your pediatrician but your insurance company.

Questions about Pediatrician and Billing...normal to pay copays?

Call insurance. I had a similar issue - I was billed for a well visit by accident. The issue was quickly resolved.

Re: Questions about Pediatrician and Billing...normal to pay copays?

I have called insurance, and they said that they can't process it differently because it's the way the pediatrician's office is coding it. Even though flu shots and wellness is covered, my dr charges for a physician visit in addition. I am only allowed one dr visit a year for wellness without the copay for dr visit. Which is why that first wellness visit, I'm good but then for flu shots and TB readings, then they charge. I just find it crappy to have to pay for those other visits when they're wellness and preventative care because the dr is charging to see them to give them their flu shots. If I go to CVS, I pay nothing. And the nurse wasn't an option for TB reading even though I could have told you my kids didn't have TB, their arms showed nothing.

Insurance had said some doctors will charge for them to be seen while others don't. So I guess I'm just not sure if billing is done differently at other peduatricians.

Message edited 6/19/2016 10:42:17 AM.

Questions about Pediatrician and Billing...normal to pay copays?

I have united and that's how my insurance is. It's not your dr it's your insurance

Questions about Pediatrician and Billing...normal to pay copays?

Most insurance it's one well visit per year. Anything beyond that has a copay. So for flu shots, the shot itself is covered 100%, but not the administration of the shot. My understanding is you need to pay for a full visit if you space vaccines. The one well visit is covered 100%, but you're required to pay for the full cost of the visit for any subsequent shots- not the copay, the full cost. Again, the vaccine itself is covered, but the insurance will not pay for unnecessary visits so the parent has to pay out of pocket.

The TB thing is weird and would annoy me- yes, technically they CAN charge you to read it but that doesn't mean they HAVE to. I mean, you could really read it yourself- I think you'd notice if your kid had a giant red circle on their arm!

Questions about Pediatrician and Billing...normal to pay copays?

We have Oxford and something similar. We went in for my daughters well visit. No copay. They made us come back 5 days later to check her weight gain and then we had to pay a copay. Meanwhile, that was forced upon us, not like it was a shot or sick visit. Annoying but is what it is I guess.

Questions about Pediatrician and Billing...normal to pay copays?

I had to pay copay for a follow up to a sick visit. Stupid

Re: Questions about Pediatrician and Billing...normal to pay copays?

These docs are using many different billing codes Now.
Mine had to remove Earwax to see if the child had an ear infection, we had to pay over 200.00 for that plus the copay for sick visit. We were charged an extra 20.00 plus copay for a Saturday visit (we were surprised , no signs or anything). Any child 6 and under needs a full "exam" in order to Get the flu shot. It's never just the copay anymore. It's always something.

Re: Questions about Pediatrician and Billing...normal to pay copays?

I think that's annoying but pretty normal. I had to pay copays when bringing my newborn in for several two second weight checks. That really annoyed me.

The only think I might question is being charged a copay for the flu shot. How is that defined as a physician visit if all they are getting is the shot? Is the shot given by the doctor at least? In my peds office, a nurse gives the shots.

Questions about Pediatrician and Billing...normal to pay copays?

When we get flu shots, we never pay co-pays. They are 100% covered. We also did not pay a co-pay when they had to go back to check the TB reading. New walked in, gave them our name, a nurse came out looked at their arms and we went on our way. We are not happy with our pediatrician for other reasons that have to do with billing so we are switching but it looks like this is not the norm and mostl peds charge co-pays for that stuff.

Questions about Pediatrician and Billing...normal to pay copays?

We don't have to pay a copay for a well visit but, we have to pay a copay for tests and assessments done at the visit.

I had it out with our peds billing department when they charged me a copay for filling out all of the forms they sent me in advance of the well visit - which they allow you to score for self assessment.

Re: Questions about Pediatrician and Billing...normal to pay copays?

Re: Questions about Pediatrician and Billing...normal to pay copays?

I don't know about TB, but my ped requires us to see a dr for the flu shot so they can make sure the child is healthy (check nose, throat, etc). It annoys me to pay for the copay (especially this year when DD was under 1 year and needed the booster, too!). But it didn't annoy me enough to change peds. If other things bothered me, too, then I'd change. But $50 per year wasn't worth the change IMO.

ETA: I just saw other posts, and it is the ped, not the insurance. Well, it could be insurance, but not in this case. Flu shots are 100% covered. If the OP is paying a copay for the visit, it's b/c the ped is billing it as an office visit + flu shot. That's how my ped does it. I tried arguing it, but had to pay it.

Message edited 6/20/2016 10:44:13 AM.

Questions about Pediatrician and Billing...normal to pay copays?

When you go in for the flu shot do you see the Physician? Does he/she perform an office visit? By this I mean does he/she perform an exam? Ask if there are any current complaints? And provide anything that would require a medical decision to be made?

Questions about Pediatrician and Billing...normal to pay copays?

Our Dr bills children 3 and under for an office visit for flu shots since they get a brief exam first. For children 3 and over - they just get the shot.