Is it normal for health insurance to not cover baby vaccinations?

Question

I'm appalled to learn Aetna won't cover my sons shots.

Answer 1

All insurance companies are different.  It is however your policy is written.  I would look into it more.  Get the papers out you would have signed and the book you should have been given.

Answer 2

If it's a "major medical" policy, or you haven't met your deductible yet, or it's an "accident/emergency" policy, then vaccinations aren't covered.  

MOST major ppo/hmo plans cover vaccinations, after the deductible is met.  

Answer 3

That does not seem right.

They PROMOTE them usually, so their costs are lower in the long run. . . WEIRD!

Answer 4

Most states have laws about mandated coverage for well-child care, including some standard vaccinations.

However, there can be caps on that coverage.  (For example, in Ohio, I believe the well-child minimum coverage is $750 per year towards a specific list of services.)  Also, just because the service is "covered on the policy" doesn't mean that your deductible wouldn't apply...even though the service was covered, you may still have to pay for it.  (Getting credit towards your deductible in return.)

So...I guess that's my question for you...are you sure that well-child vaccinations actually are "not covered" on your policy?  Or do you mean that you would still have to pay your deductible for the services?  (If something counts towards your deductible, its still a covered service.)

What state do you live in?  Someone can verify what the well-child mandates are in your state.   (Again, keeping in mind that just because they are "covered" doesn't mean you won't have to pay for them.)

If it turns out they truly aren't covered, I'd recommend getting the shots at the health department.  Its almost always cheaper to do there than at your doctors office.  (If they are covered, always go to your doctor, to get in-network benefits of course.)

Answer 5

I used to work for Aetna and somehow I'm not surprised. However, most insurance companies do unless they are experimental in nature or you don't have your son on your plan.

Answer 6

Some employers don't carry the rider for pediatric well care. Aetna does cover well visits and vaccines - IF the employer selects the rider.

Personally, I'd call your HR person at work and ask them - some companies don't have many people with little kids, so they don't generally offer that type of plan, but they might do something for you.

Otherwise, look into state-sponsored vaccines. I know New York has this program - it's called Vaccines for Children (VFC) - the state purchases the same vaccines the doctors do, but in such a large quantity, they get a huge discount. (Vaccine companies sell the vaccines at the more you buy, the cheaper they are.) So, then the doctors get the vaccines for next to nothing and can sell them for less than $20 a dose to uninsured or underinsured (meaning: kids who have insurance that doesn't cover shots) patients. If your pediatrician's office doesn't know, call your local health department.