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3 Ways to Estimate the Cost of Pediatrician Visits Before You Go!

3 Ways to Estimate the Cost of Pediatrician Visits Before You Go!

The final bill for a pediatrician visit can vary widely, from a few hundred dollars to thousands. Learn how to save!

Not sure how much to set aside for “pediatrician cost” in your baby budget? You’re not alone.

When you’re having your first child or changing pediatricians, you could have little to no reference for what to expect for the actual pediatrician visit. After all, there are out of pocket costs, even if your insurance says it covers child visits. When bills come months down the line, you may have completely lost track of the price tag. Worse still, you might not know the difference between the cost of a well child visit versus a sick visit. (Yes, the bill may be different for the exact same amount of time in the pediatrician’s office). Here’s what you need to know before you go to a pediatrician visit —here are the best ways to help you prepare.


Here are three ways to get ahead of the cost of pediatrician visits:

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. Well child visits may be free, especially for infants. These are to chart your child’s growth. During this kind of pediatrician visit, the doctor or nurse may conduct a development assessment.

However, for sick visits, parents might be shocked by how much a family medicine practitioner charges. If this scares you, remember, 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.

teddy bear, healthcare, pediatrician visits

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 or well child 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 is the cost of pediatrician visits when your child is sick with common issues like fevers or ear infections?

Last, but not least, (3) confirm whether the board-certified providers you’re considering are truly in-network for your insurance plan.

This kind of general care questioning about the cost of pediatrician visits is best done before visiting a doctor, so your child can get the best care for preventative care, well baby visits, well child visits, etc. Costs may vary depending on your child’s age, the doctor’s own rates and additional fees, and any prescribed treatment. Although pediatrician visit costs can feel like a moving target, there are multiple ways for parents to budget for the cost.

counting cash

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. This includes the cost of giving birth to your baby or visiting a doctor with your child after birth.

nurse, medicine, doctor

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 from the doctor (or their office) 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 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 like well baby visits, remember that final bills can include things like a physical exam, vaccinations, 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 this pediatrician, you have had to pay doctors before, and this visit is really no different. It is important to know that you’re not alone in wanting to know what you can afford.

Just like parents share info about pediatricians in group chats, they also share recommendations by health need and price. If you look online, you can see lots about recommended doctors — from cost, Medicaid acceptance, bedside manner with infant patients, and more. There, you can also see if parents complain about the cost of their baby visit. You can get some answers about your physician costs from people who’ve already trusted their kids’ and baby’s health to this doctor.

laboratory, analysis, chemistry

If you have a friend or family member who uses the same pediatrician, you may be tempted to ask how much they paid, but their individual visit specifics and insurance coverage may make costs very different for you. There are many tools out there to empower you to better understand your financial expectations and to plan ahead for the cost of pediatrician obligations.

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 (if you’ve already been slapped with a bill) to 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 (including Medicaid) not only based on the annual premium costs but also the estimated costs of your most frequent medical needs – from pediatric preventive care to a physical exam for your baby to postpartum care. You’ll want to make sure that they cover more than just basic vaccinations. Here are a few different resources to consider:

PreggyFinance.com is sharing publicly available resources and does not endorse or verify any of the companies/sites listed.

Check out the PreggyFinance course to learn more about how you can budget for your health needs and your baby’s needs. Well child visit info, postpartum care, and more — get the answers you and your child deserve!

 

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