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Thursday, January 13, 2011

6 month well visit

Sean is 13lbs even, He gained 1/2 an oz since Monday. He's 25.5" long. Yay!! Sean's testicle finally came all the way down so no urologist for us. Sean showed all of his tricks and only whimpered when he got 2 shots. We go back in 2 weeks for the Dtap vaccine. I wasn't going to give Sean 4 shots in once visit. I just don't like that. I really don't even like to give 3 vaccines in one visit. It just seems like so much to give one little person.

Then I had to fight for my son's diagnosis. Our insurance makes it so that we don't have to pay for well visits starting this year. The pedi's office automatically charges if there is a 2nd diagnosis. So the 1st diagnosis is always well child (unless of course we go in because one of them is sick) and then they put the 2nd as trisomy 21.

So today I asked how come I'm paying for the well visit? The girl said because there is a 2nd diagnosis. I said ok, but it's not like your treating the trisomy 21. She said, "but we're monitoring it." And I asked "for what? it's not like it's going to change and you can't treat it." I asked if my logic was off or if their practice was off. So she tried to argue that they monitor the trisomy 21 for problems. She said "it's like a heart defect. They monitor it." So I said, "ok, but a heart defect is treatable and does change."

Again I argued the point that he's always & forever going to have 47 chromosomes. It's never going to change & it isn't a disease. If he develops something related to the trisomy 21 then that's what they'd be monitoring & treating. She finally agreed with me and didn't charge my well visit. :)

I bet you didn't know I was now a lobbyist. Who knew that I'd be the one to take it on? I guess if anyone should be doing it, it's me right? I have a big enough mouth.

So now we wait. If & when Aetna decides not to pay for the well visit because of the 2nd diagnosis, I'll be arguing with them too.

4 comments:

  1. Good for you! That is CRAZY!!! I'm so glad you spoke up and made her think. My experience with Aetna is that they will, indeed, deny the claim. I swear their motto is to deny first, ask questions later.

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  2. Geez I hope not. I'm still arguing with them over pre-op testing because it's billed under pediatrics instead of surgery. Such a pain in the ass.

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  3. You go Jen. Aetna is notorious for trying anything to get out of paying. I had to take them to small claims court once over 1k they would not return to me and they actually sent a lawyer.

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  4. Hi, I just wanted to say good for you on arguing with the pedi's office. My daughter does have a heart defect and her pedi has never charged for a 2nd diagnosis on her well visits. She has a cardiologist to monitor her heart, her pedi is just for every "normal" baby stuff.

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