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Old 07-14-2011, 04:48 PM   #1
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Question Is it true that your HMO can say when you have all vaxes done?

My ped today told me I had to have all of Olivia's shots done by the time she was 2 (up to date) or when she was audited that my daughter could be dropped from insurance due to not following regulations???

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Old 07-14-2011, 05:06 PM   #2
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Re: Is it true that your HMO can say when you have all vaxes done?

i have NEVER heard that one before. not saying its true or not but as far as i know its the parents choice not the insurances or the doctors that decides when the shots are done or if done at all! wish you the best in finding out and bump so perhaps someone can help a bit more
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Old 07-14-2011, 05:07 PM   #3
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Re: Is it true that your HMO can say when you have all vaxes done?

i don't think so, but they can absolutely refuse to pay for them.
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Old 07-14-2011, 05:09 PM   #4
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Re: Is it true that your HMO can say when you have all vaxes done?

Maybe? I don't know if they could technically drop her from insurance, but they could totally be a pain in the rear about wanting to cover vaxes and visits to get them after age two that are on the recommended schedule for before that age.

I know that our state medicaid/familycare/kidcare will not pay for shot visits to the ped after age 2 (except for the boosters right before kindergarten), you have to go to the health department for any after that...they consider each visit that a child gets a shot to be a "well-baby" visit, and I guess after age two they only want to cover one well-baby per year. DS is five and getting the kindergarten vaxes, three total, and we are splitting them up. He got one at the peds office with his five year well-check, we have to go the health department to get the others for no cost (well, we have a small copay), or we can pay out of pocket to our ped for a shot visit, plus the cost of the vaccination (something around $20 total for both combined, he offered to discount them both for us since he knows we split them up like we do because of reactions, not just because we're being lazy about following the traditional schedule/taking our kids to visits for no reason like apparently a lot of his patients parents do). They don't want to cover the all of the vaxes from the peds office unless they're all done at the same time. Seems kinda stupid to me since it would be so much easier to just keep all of the records at the same place vs. having them at a peds office plus the health department, but whatever.
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Old 07-14-2011, 05:16 PM   #5
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Re: Is it true that your HMO can say when you have all vaxes done?

I'm just using my own logic but I don't think your insurance company can drop you because you are "not following regulations." If that were the case the insurance companies would be dropping diabetics for not following treatment plans, smokers for not quitting smoking, etc. -- anybody who's expensive to cover would be dropped.

Also, the state laws say you must be vaccinated to attend public school (and then provides exemptions for religious reasons-48 states-and philosophical reasons-18 states-and medical reasons-all 50 states). But I'm almost positive that's related to admittance to public school and not tied to, uh, just breathing the air and living your life, KWIM? I think the pedi is blowing smoke.

In your shoes I'd probably just call the insurance company or contact your state's insurance administrator and ask. You don't have to identify yourself to the insurance company. You could just say your doctor told you X, but you don't intend to comply because it is against your religion, do they as the insurance company have any such policy.
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Old 07-14-2011, 05:52 PM   #6
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Re: Is it true that your HMO can say when you have all vaxes done?

I'd definitely contact my insurance company, but I definitely think it's possible. Insurance companies can pretty much do whatever they want
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Old 07-14-2011, 05:58 PM   #7
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Re: Is it true that your HMO can say when you have all vaxes done?

Maybe the Ped suffers a penalty. Call your HMO. I decided to start slowly getting my daughter vaxed STARTING at age 3 and my Ped had nothing negative or scary to say at all. Sounds bizarre.
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Old 07-14-2011, 05:58 PM   #8
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Re: Is it true that your HMO can say when you have all vaxes done?

Nope, not true. We've gotten "letters" with incentives....but other than that, no. Your baby. Your choice.
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Old 07-14-2011, 06:01 PM   #9
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Re: Is it true that your HMO can say when you have all vaxes done?

Your choice, but if you choose "no" I assume they have the right to not insure you. The vaccinations are to ensure you are sick less often and less severely, and if you're choosing not to use them it'll end up costing the insurance company more money in the end - I can't see why they wouldn't either charge you more to cover that cost or drop you.
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Old 07-14-2011, 06:41 PM   #10
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I wouldn't THINK so, but like someone said...they all have their own rules and can do whatever they want.

I would call your insurance company and check it out.

I do find it kinda weird that your doctor would even know any insurance type stuff. They have office staff for billing and are hands-off when it comes to the financial side of things (that's how every doctor that I have ever encountered has been anyway).
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