Reality Check . . . Do You Take Installments?

I knew that the whole childbirth process was gonna be expensive, but we've just been blindsided by Blue Cross/Blue Shield to the point where it almost seems it would be CHEAPER to NOT have insurance on Nicholas this year and sign him up after his first birthday.

Everybody knows how basic insurance policies work: Most are 90%/10% or 80/20 or something like that. Of course, you have your annual deductible--something like $300 or $500 that must be paid first before the 80/20 stuff starts kicking in. But alas, hidden in the deep, dark, illogical corner of the benefits guide, without any provision for newborns and infants, is apparently something called a maximum wellness benefit.

The first sign that something was up was a bill from the pediatricians office not long after his first round of shots (8 weeks). Something to the tune of 400 bucks or something. Then we got the EOB from the insurance company, and as I analyzed it, I noticed that SOME of the charges from that day were paid, while others were not. I called. "Your maximum wellness benefit is $200." OK, so what about babies, and shots? 200 dollars max. So once the insurance company pays that 200 for any expenses that are flagged as "wellness", well, the rest is 100% up to Mommy and Daddy. How crazy is this? A baby is supposed to go to the doctor at 2 months, 4 months, 6 months, and a year. Most shots occur before the 2nd birthday. While I realize that the average John Doe doesn't show up at his doctor's office and say, "I'm feeling quite nice today--and I wish to see a doctor!!" and thus the $200 limit is never really an issue, surely there must be some sort of provision for babies during their first year. Nope. Sorry, dude...It all comes down the specific company's contract.

So Nicholas's 4-month appointment was 3/21. Would you like to hear the breakdown of this visit? $123 for the doctor to examine. OK, no prob--doc went to school for that. He had four shots--costing $98, $60, $51, and $118. Oh yeah, each injection carries an "admin fee" of $25 for another $100. If you're not adding that up, let me do the math for you: $550, all totally uncovered by insurance. So now we're running up a tab that's over a grand. Nice. Heck, with two more similar trips (6 months, 1 year), we might bust 2 grand!!! Now, here's where the logic really breaks down for me.

We're paying approximately $100/month for Nicholas's coverage on our insurance. So for $1200/year, this coverage is getting us, let's see...........$200 in wellness coverage. Why bother?? So let's assume that we end up paying $2000 to the Pediatrics East and $1200 to Blue Cross/Blue Shield, that means that we'll be out $3200 for insurance coverage that saved us $200. Wow, I guess I can't be ALL that mad--there was that one prescription........