RE: Insurance and Underimmunized Kids

[Guest guest]

1) My experience is that most private insurance will not cover both

visit codes at the same time and will ‘bundle’ them into one

quasi-fee. I actually seem to get more consistent results with Medicaid

and adding all the modifiers. State plans are complicated but they will usually

pay if the code is there. For private ins, I usually just bill for the

physical and don’t get paid for the sick part. Sad but true.

2) I admit I do see families with unimmunized kids. The peds

practice here doesn’t because it is a large, multidoctor practice with

lots of sick and well kids sitting in the waiting room at one time and is an

incubator for every germ known to man. I tend to see homeschooled kids

with parents who are suspicious of vaccines. I always state that I am in

favor of vaccines, and explain why. Sometimes just offering to spread the

immunization schedule out will convince them to try it. Sometime there is

one that worries them or they want to wait until their children are older.

We have long discussions about what diseases are really worrisome (we still get

measles from migrant workers around here once in a great while) and what might

not be so important. Often they will forgo the rotavirus, Hep A and

Varicella but will proceed with the tetanus, pertussis, polio and MMR vaccines

eventually. I may not agree with their views but I can see where they’re

coming from. And I’d rather cover them for some diseases than none

at all. By the time they get to college and need them for admission to a

university, they usually decide for themselves what they want to take.

Hope that helps,

Tonya S. Little, MD

1704 Glendale Drive SW, Suite C

NC 27893

fax

cell

tslittle@...

From: [mailto: ] On Behalf Of Ardiana Maloku Teran

Sent: Thursday, December 29, 2011

4:06 PM

To: IMP

Subject:

Insurance

Hi

everyone

Does anyone know if private insurances pay for both a well child exam and a

sick such as a rash at the same time?

Also, how do you deal with families who want you to see their child but refuses

to get immunized??

Ardiana

Orange doc family medicine

Clermont fl

Sent from my iPod