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Old 07-14-2011, 06:45 PM   #11
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Re: Is it true that your HMO can say when you have all vaxes done?

My ped Dr. told me that for state healthcare (or medicare - I am not sure what it is called...for kids)...that the PEDIATRICIAN OFFICE could lose funding or rights or whatever if they do not vaccinate the kids in that program on the right schedule...or get them up to date as fast as possible. He said that the OFFICE gets audited and will be "dinged" for noot having those kids on the right "track"

This came up b/c I didn't want my kids getting so many shots all at one time...he had NO PROBLEM with me making that decision (we are on private insurance) and said it was fine...I asked him b/c the receptionist was giving me a hard time and was the one that told me we couldn't delay any of them...I also called my insurance company and they said they cover $500 (or some amt) for well-baby check ups each calendar year...that includes vaccines as well...they did not care WHAT shots the kids got or if they only went one time a year...just that all they covered was $500 worth.

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Old 07-14-2011, 11:57 PM   #12
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Also wanted to add that group insurance through an employer is usually very different from an individually-purchased policy. If you are covered in a group policy through work, the insurance company cannot go through and pick and choose who to cover.

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Old 07-15-2011, 12:33 AM   #13
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Re: Is it true that your HMO can say when you have all vaxes done?

we got kicked out of our peds office because of the audit issue with insurance. They basically want all kids vaccinated on the "recommend" (not regulation) schedule. Plus the doctor told me in these words (I was 8 months pregnant) that my DD could KILL my son if she was not properly vaccinated. Um ok WHATEVER!!

oh and I should say we found a different peds that allows ME to be the parent and does not tell me I will kill my child my not having him or her vaccinated.

Last edited by HRM's MOM; 07-15-2011 at 12:34 AM. Reason: more info
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Old 07-15-2011, 06:45 AM   #14
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Re: Is it true that your HMO can say when you have all vaxes done?

Quote:
Originally Posted by poppan View Post
Also wanted to add that group insurance through an employer is usually very different from an individually-purchased policy. If you are covered in a group policy through work, the insurance company cannot go through and pick and choose who to cover.

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This. If it's group coverage thru an employer they can't do that. With an individual policy they have more leverage to do that, I assume. I would think that if you can legally waiver them in your state, though, that the insurance couldn't drop you if they have a waiver on file, but I don't know that for sure.
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Old 07-15-2011, 07:14 PM   #15
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Sure they can refuse to pay if you don't follow the schedule. I would negotiate a shot only visit charge with the doctor. Since you're on a HMO the Dr is getting paid for the vax regardless of when so its the nurses time you'd be paying for.

Eta: ditto on the group stuff. They cannot drop your lo but they have the right to refuse coverage. Is call the company instead of taking drs word for it.

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