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Insurance question for moms

Since Jesse is a State employee we get a few different options on our insurance plans (hello, confusion)... They will no longer offer our current plan in 2011.  Argh! This will end up covering all three of us next year but I am stuck between a couple of options.  So any info you can offer would be helpful.

For children under 2, how many times have you had to make a trip to the ER?

How about an Urgent Care/ After Hours care place?

Lastly (I should know this), is a pediatrician considered a specialist? 

Any reason you would never choose an HMO? (It looks like all of the doctors and hospitals I would want are on the HMO plan.)  Our primary care doc is great about referrals, I am not worried about that.   

Re: Insurance question for moms

  • For children under 2, how many times have you had to make a trip to the ER? (knock on wood) we have not had a reason yet to take M to the ER.

    How about an Urgent Care/ After Hours care place? We can usually get into see our pedi pretty quickly if we need to so we haven't had to go to these types of places yet.

    Lastly (I should know this), is a pediatrician considered a specialist?  I could be wrong but I don't think they are. Wouldn't they be consider the same as a general practioner?

    Any reason you would never choose an HMO? I have never been on HMO so I'm really not much help...sorry.

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  • For children under 2, how many times have you had to make a trip to the ER?   We have gone with C once, but we had lots of specialist follow-up visits.

    How about an Urgent Care/ After Hours care place?  Our doctor has an emergency line and Saturday "sick only" hours, so never.

    Lastly (I should know this), is a pediatrician considered a specialist?  not with our plan.

    Any reason you would never choose an HMO? (It looks like all of the doctors and hospitals I would want are on the HMO plan.)  Our primary care doc is great about referrals, I am not worried about that.    I worry more about copays and deducible than anything else.  Maybe that isnt smart of me.

  • 1 ER visit at 5 months for nursingmaids elbow during a diaper change

    2 Urgent Care visits (14 months and 21 months) one for throat one for ear. BUT we didn't have a pedi at the time so that's why we went there (plus it one was a Saturday)

    Not sure about the pedi/specialist question. Not very familiar with HMOs either. Basically I'm good for nothing :0)

    Lilypie Fourth Birthday tickersLilypie Second Birthday tickers
  • We've been to the ER three times - twice for reactions to meds; once for a dislocated elbow.

    We've only been to Urgent Care once - the other times, we got into his family doc pretty quick.

    The plan we have now, peds aren't considered a specialist. But OSU's tossing the health plan I have now out the window, and we're not sure if peds will be considered specialists or not under the new plan. I think they will not be considered specialists, but we're discontinuing health coverage through OSU (moving to Tricare) in 2011 anyway, so I probably will never know...

    [url=http://charmedkindoflife.blogspot.com/].:.Charmed Kind of Life [2.17.13].:.[/url]

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  • For children under 2, how many times have you had to make a trip to the ER? Once

    How about an Urgent Care/ After Hours care place? Once (the ER and Urgent care were for the same illness, we went to the Urgent Care first and they sent us to the ER)

    Lastly (I should know this), is a pediatrician considered a specialist? Not 100% sure, but I don't think so

  • For children under 2, how many times have you had to make a trip to the ER? Luckily, we have never had to take DS to the ER.  DD made one trip to the ER when she was very little for an allergic reaction.

    How about an Urgent Care/ After Hours care place? We've never taken either of the kids to one of these, but I have considered it once for DS.

    Lastly (I should know this), is a pediatrician considered a specialist? Not on either of the plans we've been on since DS was born.

    Any reason you would never choose an HMO? I wouldn't "never" choose one, but I have been glad that we aren't on one.  It would have probably taken even longer to get an appointment when DS had to see an allergist because we would have had to go through the process of putting the referral through insurance company's process as well.  If the difference in cost is significant, though, it would probably be worth it.
  • ER: Once (knock on wood that's the only one for a very long time)

     Urgent Care/AFter Hours: Three (he got a series of illness that ALL started on the weekend...boo)

    Under my insurance a pedi is not considered a specialist but I would check with your potential insurance.

    I have no advice/opinion on an HMO. Good luck!  

    Baby Birthday Ticker TickerBaby Birthday Ticker Ticker
  • I'm not a mom, but I do work in medical billing.  From what I've seen HMO's generally require precertifications on everything.  That's why you hear about the long waits to be seen for things. 

    Pediatricians are generally considered PCPs for your children. 

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