The cost of a doctor’s visit can vary widely, from a few hundred dollars to thousands. When you’re having your first child, you could have little to no reference for what to expect. And when bills come months down the line, you may have completely lost track of the price tag for the well or sick-baby visit. Know before you go—it is the best way to help you prepare.
Here are three ways to get ahead of the cost of a pediatric visit:
1) Ask your insurance provider first
The type of insurance you have largely determines much of your out-of-pocket costs. Most major medical insurance plans cover most types of visits, but how much they pay upfront or reimburse later is anybody’s guess—based on your benefit level. You wouldn’t be the first parent to find out that you’re uninsured or under-insured after a higher-than-expected medical bill comes along.
In their first year of life, babies are expected to see a pediatrician about 7 times—and that is if they’re considered perfectly well. If any one of these visits diagnoses a problem, the visits and the bills could mount.
The best way to begin to understand your expected bills is to call your insurance company. You have to ask directly about the amount of your annual deductible and whether pediatric visits will be billed against the deductible or not. As for follow up questions:
First, ask (1) Are well-baby visits covered at 100%? If not, what is the co-pay and at what rate are visits reimbursed?
Second, ask (2) Are sick visits covered under the same terms? If not, what are they?
Last, but not least, confirm if the providers you’re considering are truly in-network. This can be a moving target, so let’s dig into how you begin to find out.
2) No Surprises Act: Ask Prospective Medical Providers for a Good Faith Estimate
Did you know that by law, you have the right to request an estimated bill for medical services before you receive those services? Thanks to the No Surprises Act, people residing in the U.S. don’t have to guess the costs related to medical care. One major benefit of this estimate is that you’ll know the differences in costs for In-Network (medical providers that already have an agreement with your insurance company) and Out-of-Network Providers (medical providers that have no pre-established relationship with your insurance provider; often, you will be responsible for paying these providers directly). At hospitals and clinics, you may find that some of the doctors and care providers are in-network, while others are not. And you could be hit with a higher-than-expected bill just because of who was on duty that day and assigned to your visit.
If you just said to yourself, “no fair,” then you’re on to something. The best way to prevent this from happening to you is to ask for a Good Faith Estimate at least 3 days before your doctor’s visit. This way, if you get a high estimate, you have a few days reprieve to cancel before you’re charged for any cancellation fees. Under the law, if your final bill turns out to be more than $400 greater than the estimate, you can dispute the bill.
While it might seem unlikely to happen for a routine pediatric visit, remember that final bills can include things like exams, tests, labs, care from multiple physicians & providers, and hospital transfers. Avoid surprises by asking for estimates before arrival at the physician’s office, clinic, or hospital.
3) Last, but not least, use reputable estimators
While this might be your first rodeo with pediatric visits, it is important to know that you’re not alone. There are many tools out there to empower you to better understand your financial expectations and to plan ahead for them.
The Fair Health Consumer Tool is a great place to start: https://www.fairhealthconsumer.org/
You can plug in your zip code, the type of visit OR the visit code billed and learn more about the price estimates for that service. Estimates will look like this, with the option to see information in Spanish and/or English, and to drill down to learn more about reimbursements and add on expenses.
If you’re looking for new insurance coverage altogether, there are also cost estimators for that. You can browse and compare health insurance not only based on the annual premium costs, but also the estimated costs of your most frequent medical needs – for pediatric to postpartum care. Here are a few different resources to consider:
- State-specific Health Insurance Information Pages, like New Hampshire, Texas, etc.
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