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Annual kid screening and insurance

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  • Annual kid screening and insurance

    Our insurance has changed, and while it is still "good," it's not nearly as good was it was last year. In the past, I have been able to bring my kids to our local ped card and have an EKG and echo done, and just pay our copay. Starting this year, it will all be out of pocket, since we now have deductibles that are pretty high. I think it will end up being about $500 per kid each year to have the tests done.

    I am going to try to lobby our insurance company to see if I can get at least some of the expense covered. Most likely futile, I know, but I need to try. I am going to enlist the help of the ped card and make the case that since HCM is genetic, there are universally agreed upon guidelines for screening all children in HCM families, and that these yearly screenings are preventative. The insurance plan covers all preventative care and certain tests like mammograms and colonoscopies at 100% and are not subject to the deductible.

    Has anyone else ever tried this? Is there anything else anyone can think of that I should add in my attempt to get this covered?

  • #2
    Re: Annual kid screening and insurance

    I think its worth a shot. You might also see if you can set up one of those accounts at work to have these fees taken out "pre tax". When our kids were small - all doctor, dentist, medicine, etc. came out of this account and it was helpful (somewhat) - the hard part is trying to guesstimate what your needs are. Because - if you don't use it, you lose it.
    Marc
    Diagnosed @ 48
    Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
    Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
    AICD - Valentines Day '08, Spark Plug replaced 11/14
    After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
    Quietly going insane . . .

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    • #3
      Re: Annual kid screening and insurance

      I am in the same boat this year, but am hoping for a different result. I used to have an individual Blue Shield PPO policy that refused to pay for my son's annual echo and screening. I negotiated a cash price with the Pediatric cardiologist ahead of time (which was somewhere in the $800 range). I am hoping that my new employer based Anthem PPO policy will cover screening, but we are waiting to see. I may be right there with you next week.
      Daughter of Father with HCM
      Diagnosed with HCM 1999.
      Full term pregnancy - Son born 11/01
      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

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      • #4
        Re: Annual kid screening and insurance

        I so wish there was some kind of option for uninsured HCM patients and their kids to get low-cost echocardiograms. Both of my kids are due for a screening but without insurance, we're not sure how we will swing it. I'm going to call around and see if any of the local docs will work with us.

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        • #5
          Thanks for sharing this.

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