insurance and pediatrician question

So luckily I talked to my insurance and it is covered however a nurse the other day told me that some insurance companies aren't paying for circumcisions bc they consider this cosmetic surgery ... Has anyone else run into this?

Also ... How did you go about choosing your pediatrician?

 

Our insurance paid for the circumcision and it was done at 7 weeks in a pediatrician urologist office. I feel much better for doing it there, the OB that was going to do it at birth seemed always rushed and I felt like we had enough stuff to deal with already so we postponed it and I am glad we did it this way.

About choosing a pediatrician, around 32-34 weeks I called 3 places around our house and we went to an open house at the one place. I liked the way it looked and also I liked the doctor that we met there, so we went with the first place we visited. I have several friends who take their kids to that practice so I knew it was good. It's a good idea to go visit places and meet doctors now, I think if you call them you can find out if they have an open house schedule or if you can just go and visit when you get a chance. The pediatrician we picked came to the hospital every morning while we were there and visited the kids, he is great, and we are glad we chose him - very laid back and relaxed, but well informed and open to consider my opinions also.

The main question I thought was imporant is to see if they have different waiting rooms for well baby visits and for sick kids visits - and most places have that. Other than that, go with your instict. You will see the pedi a lot in the first year, even with just the well baby visits, so I think it's imporant to have someone you like and trust.

 

For choosing a pediatician, you can call the local ones and see if any are #1 accepting new patients, and #2 - do new parent consults (where they introduce themselves, some of the staff, let you see the office.)

For us when we were in Tampa, there was no question where we would go, to the practice that: My grandmother worked at for 35 years, my mom worked at for 6 years in high school/college, I worked for for 2 years, the ARNP is a family friend, all of the doctor's are friends of my family so that was easy to pick out.

Once we moved to Virginia though a totally different scenario, I actually took my kids to different doctor offices twice when they were sick before I found a doctor that I liked for well visits. I don't even take them to a pediatrician in my town or county, I take them to the next county over because I like the practice and the doctor that we usually see is #1 the girl half of b/g twins, and #2 has the same birthday as A&R. But you kind of have to go with your gut feeling.


ETA: Make sure that you mention the EDS to whomever you're interviewing, you at least want someone familiar with it and what that potentially means for your A&J. And find out what hospitals they are affiliated with, if you have a preferred hospital, make sure that they have admitting and regular priveledges at that facility.

 

I've always gotten good recommendations on Drs from other Drs or from nurses. With my oldest, I didn't even think about it until she was born, duh. The hospital nurses suggested someone and we really liked him. Then when we moved about 5 moths later, we asked him if he knew someone in the town we were going to. He said, "If you like me and my personality, you should really like Dr Starr." Dr Starr was our pedi for 10 years. We even drove an hour to see him for our well child visits after we moved again, because we liked him so much. But as often as you go with a new baby, I decided we needed to switch again when I was having Spencer. I asked my. Idwife for recommendations and ended up at a really great practice, where we still go. You can interview most Drs before you go to their practice. I really like someone who is very supportive of breast feeding, will support me in spreading out vaccinations a little (I just don't like them getting FIVE at a time), and has weekend hours for sick kids.

We've had all 3 boys circumcised and I don't think insurance paid for any of them. My first OB did my oldest son's in the hospital and charged me a chocolate cake. But he was a close family friend. He died when I was pregnant with Adam so our pedi did it when he was a couple days old. And the new one did Spencer's. He was a few weeks old. He didn't gain weight really well at first, so the dr wanted to wait a bit. (Now he's 80th percentile for weight and 75th for height, so he's doing fine in that regard.)

 

With my twins, I took them to my regular family doctor and their circumcisions were covered by my insurance. I can't remember what company it was, Blue Cross Blue Shield maybe? With my third, we have military insurance so I have little choice as far as dr's and peds go. I get whoever they assign me & the kids to. I've had good luck so far, so can't complain much. Tricare covered his circumcision as well. All three where done the day after they were born in the hospital.

I would definitely ask my OB and find out from other mom's in the area who they recommend for a pediatrician. Having a split well baby & sick baby waiting area is a great idea too. With my twins since it was a family doctor and it was a small practice, they just made sure they didn't have any sick people in the waiting room when I was there with the twins.

 

This reminded me that at all three pedis we've had, when babies are very small and coming in for well-baby visits, they are ready for them and take us right back, so we don't have to wait in the waiting room. None have had separate waiting rooms, but I really appreciated that with my newborns.

 

Even if the pediatrician is not accepting new patients, if you put them down as the pediatrician that you want they will most likely accept you anyway. For example, when my son was born, the pediatrician that I wanted "wasn't accepting new patients" according to the staff when I called, however, I put him down anyway as the pediatrician I wanted, and when he came to my room he gladly accepted me no questions asked. Same incident for the girls, when I called they told me he "wasn't accepting new patients". Put his name down anyway at the hospital and he was more than glad to take us on. So, even if they tell you that when you call the office, if it's someone you really want, put them down anyway when you get to the hospital and the doc will probably be more than willing to accept you.

I choose the peditrician for my girls because several of my friends had him and they raved about how good he was; plus, my son's pediatrician retired so I had to have a new one. He also had experience with twins (my best friend at the time had twins and her girls saw him). So, for me it was a no brainer.

 

I have Blue Cross/Blue Sheild and called them, they said they cover the circumsion.

I've gotten 2 names of pediatricians. Both of them close to me too. One is a female doc that a bunch of the girls I worked with used and the other one is a male doc that Marshall's niece uses and says she loves. I guess I'll just have to call both of them and see what happens. And Bex, of course I'll be telling them about the EDS, I'm just hoping these two don't have it but we'll be able to determine that when they're born.

Thanks for all the replies!

 

Did I ever discuss the Tricare Standard/MOAA insurance with you? I can't remember. When you wrote about the babies and having to go where they say it made me think about it b/c I assume you're under prime.

 

We do have Prime and I've had a lot of people tell me about Standard and being able to pick our own docs without referrals and what not. Actually because we live so far from the base here (it's not THAT far really) I can go to doctor's here in town but honestly it's just more of a hassle. I have to worry about getting all our records together every time we move. If I stay on base, that's where all our records are and I can just pick them all up in one trip. I've also run into problems where places don't like to take military because we just move anyway. And like I said, I've never had a major problem on base. I did see one Ped back in MD that I didn't like and I just asked to never be scheduled with her again. If I was really unhappy with the service and/or Dr's on base, I would look into going in town, but so far that hasn't been the case.

Also doesn't Standard make you pay copays? I never pay a copay. I guess I could look it up on the website but it's about as informative as a blank wall.

 

Okay, I looked up the Standard info on Tricare's website, and they do have a lot of copays. Most things we would have to pay 15% of the cost, plus have a deductible which isn't much, but it still has to be paid. I don't pay anything at all now.

I can see where it would be beneficial for someone with health issues, but we are all pretty healthy. Just need a little 'routine maintenance' here and there. :lol: It's nice to have the option should I ever need it, though!

 

Yeah they do have the copay however you can apply for.Mediplus which is a supplemental insurance for tricare standard that cost $34 I think per quarter for the family and at the end of the year (bc I solely use CVS) I get a print out of what id paid out of pocket, submit that to mediplus and they'd reimburse me.

With my health problems and my moms it was beneficial to be able to pick and cchoose. I've never had some place deny me bc I was military and moving, that's odd.

Mediplus is through MOAA

 

From their website, we'd have to pay almost $50 a quarter (3 kids), so it wouldn't really be beneficial for us on top of all the copays. Since we don't go very often, we wouldn't spend more in copays to make the premium worth it, know what I mean? The baby is the only one who goes in on a regular basis, the rest of us barely go in once a year.

 

They might have gone up on their rates. With moaa and tricare stanard there are no copays, it covers the extra 20% standard doesn't so in essence its having 100% coverage but you choose where you want to go.