Children's Insurance Question

[castleview]

Hi,

My husband has an excellent benefit plan, but I just learned that between the ages of 6 and 10 my kids will only be covered for a physical every other year. I called the insurance company and asked them how they came to that. First they said that's in Connecticut's Standards. I said "Who are they? Is this a commission the state put together or is it a private organization?" The man asked to put me on hold. When he came back he said that's what the American Association of Pediatrics recommends. Eventually, I got to the manager who told me that the previous customer service rep was misinformed regarding the Connecticut standards and that they go by what the AAP says. I find this very strange since every pediatrician I've heard of recommends physicals every year. I was at the AAP's website and couldn't find anything that said that. Does anyone know of this?

 

[golfgal]

None of the pediatricians we have had recommend a physical for a healthy child every year over the age of 5. Also, it isn't your insurance company making those decisions, it is the employer who took out the insurance policy. You need to speak with the HR/benefit department to express your concerns.

 

[Barb D]

I think its pretty standard for kids to have physicals every other year.

 

[DVCLiz]

Yep, my pediatrician started every other year after the girls had their 6 year old exams - so we went at 6, 8, 10, etc. Actually, they were both usually sick enough during the year to be seen in the office for something each year, so I never had to go too long without a medical exam, but the "well child" visits went to once every two years.

 

[castleview]

Yep, my pediatrician started every other year after the girls had their 6 year old exams - so we went at 6, 8, 10, etc. Actually, they were both usually sick enough during the year to be seen in the office for something each year, so I never had to go too long without a medical exam, but the "well child" visits went to once every two years.

That's mine. She's never sick. I just wish I had known that this was standard before I took her for her physical. Like I said, everyone I know has their kids in once a year and that's what the pediatricians I know suggest. Thank for the info ladies. At least I won't feel bad if I can't afford the annual.

 

[castleview]

None of the pediatricians we have had recommend a physical for a healthy child every year over the age of 5. Also, it isn't your insurance company making those decisions, it is the employer who took out the insurance policy. You need to speak with the HR/benefit department to express your concerns.

I know the insurance company doesn't make the decisions, but they've sent me several rejections that the doctor's office had to send through again. Call me a conspiracy theorist, but I wonder if they feel some people might just pay a bill thus saving them money.

I guess I could dream that they'll cover this appointment and then when she's nine instead. I know it won't happen, but I have no problem harassing and annoying my insurance company.

 

[disney junky]

Benefits really have changed since my kids were that age.

 

[Lisa loves Pooh]

We just took the 4yo in and I asked how often since I didn't take my 6yo in this year.

Once they have all their shots (by about age 5 though my 4yo completed all hers last week), then they can go every other year (so 7, 9, 11 or so).

Nothing prevents you from booking an appt sooner if you suspect there is an issue with your child that needs addressed.

 

[TheGoofster]

Under our insurance plan, nobody in our family is entitled to a physical.
This always strikes me as completetly absurd. You would think an insurance company would require physicals, not deny them. Isn't it in their best interest to pay 150 bucks or so once a year to possibly prevent 15 thousand bucks (or a whole lot more) later on because a preventable problem wasn't caught?

 

[wdwmom2]

My only concern with the every other year thing would be if my children participated in a sport that requires a physical. If it has been over 1 year since the last physical, the school, organization, etc. may not except the physical. What do you do in that case???? I am assuming you would have to get your child a physical and pay for it out of pocket .

 

[disney junky]

Under our insurance plan, nobody in our family is entitled to a physical.
This always strikes me as completetly absurd. You would think an insurance company would require physicals, not deny them. Isn't it in their best interest to pay 150 bucks or so once a year to possibly prevent 15 thousand bucks (or a whole lot more) later on because a preventable problem wasn't caught?

That's the thing. We used to have to pay for all doctor visits, full price. They we went to a copay which now is $40 or $50 a month, not at all bad, but it does increase every year, and now we get office visits for $20. The prescription plan is where we (or I should say those who need ongoing prescription drugs) save a lot of money.
Ours didn't used to include mammograms...how silly was that.

 

[barkley]

My only concern with the every other year thing would be if my children participated in a sport that requires a physical. If it has been over 1 year since the last physical, the school, organization, etc. may not except the physical. What do you do in that case???? I am assuming you would have to get your child a physical and pay for it out of pocket .

in these types of situations the parent can do well to find out what the organization or school district over the sport defines as a 'physical'. reason being is it can differ from a 'full blown' physical that the insurance company only covers every 2 years. my pediatrician does the standard physical as well as a 'sports' physical that's based on the norm for the local sports groups requirements. the sports physicals are much less costly for those who pay out of pocket.

 

[malibuconlee]

My only concern with the every other year thing would be if my children participated in a sport that requires a physical. If it has been over 1 year since the last physical, the school, organization, etc. may not except the physical. What do you do in that case???? I am assuming you would have to get your child a physical and pay for it out of pocket .

When I was in school we had a sports physical program. Some of the doctors in town and the hospital did it as a joint effort. The cost was $10 or $15. We would go to the gym and do some of the paperwork/exercises. Then they would load us onto a bus and drive us to the hotel where we would use the restrooms with an adult standing outside the stalls "overseeing" while we did our urine sample. Then to a conference room where they had several people doing our blood draws. They did this the last month or so of school, then we were given the name of the doctor we were assigned and made an appointment for the physical exam part.

It was a really great program that we just took for granted because it had always been that way. We actually complained because they usually did the blood draw the week of prom and us girls would have bruises from the needles to go with our prom dresses.

 

[wdwmom2]

in these types of situations the parent can do well to find out what the organization or school district over the sport defines as a 'physical'. reason being is it can differ from a 'full blown' physical that the insurance company only covers every 2 years. my pediatrician does the standard physical as well as a 'sports' physical that's based on the norm for the local sports groups requirements. the sports physicals are much less costly for those who pay out of pocket.

I understand what you are talking about, but I fill out physical forms everyday at work. Almost every form that I encounter requests most of the information that is done in our "standard" physical, and occasionally more. Most forms require eyes and ears to be tested, but we only do them routinely at age 4 - 6, 12, 16, or if there is a problem or the parents request it to be done. There is also the "talk" with the teenage group. The doc discusses sex, alcohol, tobacco, and social issues. This "talk" is not required on sports forms. We don't do any regular labs, except at age 1 and 2 (hemoglobin, hematacrit, lead), which are a requirement for the school system. Only time we do labs is if there is anything that warrents it. I do run into forms which do require labs, blood and/or urine, but not that often.

So for our office, a physical is a physical, sports or just routine. But if insurance doesn't cover it, you get a discount if you pay in full the day the service is rendered.

Hope I didn't confuse you . I think I just gave myself a headache trying to explain it.

 

[golfgal]

My only concern with the every other year thing would be if my children participated in a sport that requires a physical. If it has been over 1 year since the last physical, the school, organization, etc. may not except the physical. What do you do in that case???? I am assuming you would have to get your child a physical and pay for it out of pocket .

I know in MN kids are required to have a physical every 3 years if they are in sports so it isn't an issue here. Most towns have a physical night and do the physicals for everyone. One thing to keep in mind too, if you have a concern you don't need a 'physical' to have it looked into, just a regular appointment which should be covered.

 

[4formickey]

WE have b/bs and my employer does not pay for the physical so to get around that we take the child to the doctor and tell them something is going on so that they can get check out. They won't pay for the wife to get a pap smear unless there is a discharge so she must tell them something is going on. This could be one reason it cost so much for health care because the are to cheap to pay for routine care that can prevent higher medical cost.