Travel Vaccinations, ever covered by insurance?
 

Just curious if anyone has had there travel vaccinations covered by their medical insurance...

Its seems silly that they wouldn't.. cause if I contract Yellow fever (for example) they will be paying for the treatment when I get back.... so you would think they would want to prevent...

Of course you'll have to check with your individual plan, but they should be covered.

Agree you should check with your plan as all of them vary. If you have insurance thru your company-they are the ones who pick the type of plan and if there are any additional riders of what they will and will not pay for. This is there way of somewhat controlling the cost of the premiums.

Also, many insurances do not do things that "make sense". What I mean by that is some of them don't cover your physical-yes this should prevent you from getting sick-they would rather gamble (I guess) and take the chances and only pay for the ones who do get sick. They also may consider vaccinations that are not required in this country something like a cosmetic procedure-something that really isn't neccessary. (necessary-defined on what is relative to them and not you).

Many insurance companies have stipulations on vaccinations themselves-and restrict which ones they will pay for especially if you are an adult and not a child. They will also restrict payment of the vaccinations according to the diagnosis (ICD-9) code filed with the vaccination code (CPT). With most vaccinations you file them using a V code ("well/history of" ICD-9 code VS you being a "sick/condition/disease" code-starts with all numbers). Many insurance companies will not pay on certain V codes. Most of the time they do this bc they do not either pay for "routine services-well checks" or they have found the most commonly filed ICD-9 and have stated the doctors should use a more specific ICD-9 if avaiable-if not you are screwed and have to pay for it yourself. (I could go on more about how you have to go thru everyone in the world to get an insurance to cover certain DX and or procedures as a company policy..but I won't bore you death..as I know you are already sleeping!)

The best thing to do is to call your doctors office and tell them what vaccinations you are needing and why. Then get the CPT codes and the ICD-9 code they would use to file to your insurance. Then call your insurance and see if they will cover them-this will be better then saying-"I need to know if you cover vaccinations"-as there are some under your plan they will cover-I am sure. If they say they do cover them-ask them on what percentage. Some insurances will not pay them at 100%-increasing the amount you will owe additional to the copay amount you paid.

****Warning the insurances disclaimer***** Hopefull they will tell you this but in case they dont. That they can tell you yes or no when you do the above-but they will only "determine" your benefits when the claim is filed.

Hope that helps.

Shi

Well just got through.. and they won't cover any travel or education related vaccinations... UGGH its going to be 70+ for one shot alone, typhoid and I think I need another yellow fevor too... It seems ridiculous that they are willing to pay for treatment but not prevention!

Welcome to my world!!

Just a suggestion-bc they are usually cheaper on vaccinations.

Try calling your public health dept clinic and see if they have any of the vaccinations you are needing and how much they are.

My expereince:

HMO: No (travel shots come from the travel clinic and not your PCP)
Flex Plan: Yes (at least you pay pre-tax that way)

HI.. thanks for the suggestion.. that is where we are going.. but I just checked my book and its says yellow fever is good for 10 years.. so I only need typhoid at this point.. and they quoted $70, but I am nto sure if that includes the visitation fee of $35 or not... oh well not much I can do at this point.

Is the "visitation fee" for the health clinic or are you speaking copay of the doctors office?

If it's the health clinic-I am not sure-as they are offering services to people that are not using and/or don't have insurance-they are not obligated to follow certain rules. I am totally ignorant of really how there fee structure/payments are setup here.

BUT

On the other hand the doctor office visit is a totally different story. If it is the doctors office here is how it may go down:


In all the below scenerios-you are going in JUST FOR YOUR VACCINES AND NO OTHER ISSUES/DIAGNOSIS:

A) You go and get your shots-you pay for just the shot as that is the only thing billed. In this case you should not have to pay for a copay.

B) You go and get your shots-you pay for the shot (vaccination) and the administration of the injection as those are the only two CPTs billed. In this case you should not have to pay for a copay.

C) You go and get your shots-you pay for the shot, the administration of the injection and an office visit (what we call nurse visit) it is the shortest CPT you can bill for and is OK for the nurses to bill this. In this case you pay for the shot, injection and a copay. but the copay maybe overturned by your insurance company-again one of those insurance to insurance things..

D) You go and get your shots-and they bill the shot, administration and an office visit of some other sort besides the "nurse visit". This should not happen as they do not have enough to stipulate in your records to justify a visit.

Which one do I think is correct is A&B. Other coders may not-and suggest that the offices bill the nurse visit also- being in the clinics previously having to justify it to a patient...I just don't like it and do not think its fare.


Sorry to go on and on..everyone has something they can offer..first time on FT I have been able to extend my services. Any others--if I know it I can help you out--typical consult fee waived :)

get the oral typhoid vaccine instead
 

My insurance doesn't cover travel medicine either. Explain your cost concerns to the clinic. The oral vaccine for typhoid is only a few dollars and they can give it to you with instructions for taking it at home. That's what I did. $70 for typhoid injections is just way out of line when there is a cheaper alternative that works just as well. My friend on the same trip got "stuck" with the jabs. I think he dressed a bit too prosperously when he showed up at the clinic.

.....