I don't know what to do...

[aries_black]

My DD has been off and on sick for the past few months. Bronchitis and ear infection in both ears. It's gotten to the point we're in the doctor's office every month. Sometimes twice or three times a month. I know kids get sick, but I didn't think that it would be constant. I'm seriously at loss as to what to do. I also had planned on going back to

Comments

[twirlgrrl]

Ugh! I'm sorry you're having so much trouble!

The first thing I would do would be to ask for statements from the insurance company showing what was billed and what they have paid. Have them faxed or scanned/emailed to you ASAP if you can. Then you have something to talk to the doctor's office about. You may have a copay or you may even have to pay the difference between what the insurance pays and what your doctor charges depending on what kind of insurance plan you have and whether the doctor is in the insurance company's network or out of it.

Do you have an HMO, a PPO, or what?

[aries_black]

We have a HMO that we get from my mom's work. Her family group plan.

[diermuid]

Along with deductibles (which are different than co-pays) my last HMO only covered 80%. Which is better than nothing, but if you don't expect it and they go for a few tests then it quickly runs up over a hundred dollars in one visit, plus co-pay, plus deductible.

Your mom should have a thick pamphlet that came from her work about the insurance. A 2009 booklet is worth little, you'll need the 2010 book, plus knowing which plan she's on would be good. Often they have multiple levels of coverage, so a United Healthcare HMO might have a $25 co-pay with 100% covered and no deductible, or it might have a $25 copay with $80% covered plus a $600/person $1200/family deductible.

[twirlgrrl]

Hmmm... If the doctor is contracted with the HMO then you should have only a set copay for each visit and the HMO should take care of the rest. They usually don't pay what the doctor charges but the doctor has agreed to accept the contract rate by being part of the HMO network.

[diermuid]

Something that helped a friend of mine (with the consistent sickness) was to re-evaluate all the influences on the kid's health. We all know about keeping their hands washed, and on a consistent schedule, but there are odd things that I've learned over the years that may or may not apply

[phoenixscribe]

It sounds to me like there may be miscommunication regarding what has been billed and what hasn't because of the repetitive visits. Get a complete statment of your account from the doctor's office, and a copy of everything the insurance has paid on since the constant visits started. Then sit down & compare them. You may find that there's a clerical error somewhere creating all the problems with this, or that the doctor's office is holding you accountable for visits that the insurance hasn't had enough time to pay on yet