I'm Covered By Health Insurance, But My Flu Vaccine Isn't

Claire figured her health plan would cover her flu shot, and double-checked with her provider just to make sure. Then she went in to Rite Aid to get the deed done, only to discover she was out of luck because her insurance didn’t cover the specific vaccine offered at the pharmacy.

She writes:

I am writing to tip you off to some nonsense UnitedHealthCare/Medco behavior! I called my health provider, UnitedHealthCare, this morning to make sure that I am covered for a flu vaccine this year. I was informed that I am covered 100%, up to $500 a year. I then asked if it mattered whether I went to my doctor or Rite Aid and was told that it absolutely didn’t matter. So I decided it would be quicker and easier to go to Rite Aid. At Rite Aid, I gave the pharmacist my insurance information. A few minutes pass and he calls me over, telling me that I am not covered.

I tell him this must be a mistake and he agrees to call in to verify this information. Sure enough, he comes back and tells me that I’m not covered. So I call UnitedHealthCare and am told, once again, that I am covered 100%. The woman on the phone is very confused that the pharmacist was told I wasn’t covered and asks whether he called UnitedHealthCare or Medco (my prescription provider). It turns out that he called Medco. The representative tells me to call Medco to verify why this vaccine isn’t covered.

So I call Medco and am told that this particular flu vaccine is not covered. What? Isn’t there only one vaccine? I ask her whether my plan says that the vaccine should be covered. And she admits that it does, but tells me that this brand is not covered. So I ask her to check and see which brand is covered, and where I can get this vaccine. She checks and tells me that no brand is covered. So although my plan covers the flu vaccine, there is no flu vaccine that my plan will cover! She then tells me that I can mail a written appeal, but that I should wait to get the vaccine. I tell her that I want to get the vaccine early so that I don’t get the flu. But she has no advice for me. Anyhow, I went ahead and paid out of pocket, but I also mailed in an appeal.

I felt the need to write in because this is really shady! I have a good insurance plan. If anything should be covered by health insurance, it should be a freaking flu vaccine! And I am covered. But the vaccine isn’t. This is nonsense and this is deceptive practices. If I had a decent attorney general I would email him, but sadly I live in Virgina and our AG is insane. But I want to get the word out there about how shady and deceptive UnitedHealthCare and Medco are!

If you get a flu vaccine, what steps do you take to make sure you pay as little as possible for it?


Edit Your Comment

  1. Mike says:

    Seriously, how long are we going to insist on sticking with the private insurance system? As someone who lived in Canada four years, let me tell you, universal health care is the way to go.

    (Queue crazy right-wingers citing some rare case where a government health system failed, ignoring the fact that tens of thousands of Americans die every year because of our crazy system. http://www.reuters.com/article/idUSTRE58G6W520090917)

    • digital0verdose says:

      Holy crap you better hide under a fireproof rock because people around these parts don’t like the logic a universal healthcare system provides. These people like that their lives are essentially dollar signs and are afraid the gov’t is going to take over their lives by keeping them healthy.

      • LadySiren is murdering her kids with HFCS and processed cheese says:

        I’ve also got UHC and was told at CVS this weekend that they won’t cover the shot at CVS, however, if I want to schedule an appointment with my doctor, it’ll be covered. It’s annoying so I’ll likely just pay the $35 or whatever it is so I don’t have to mess with scheduling an appointment.

        • LadySiren is murdering her kids with HFCS and processed cheese says:

          Huh. My reply was totally put in the wrong spot in the thread. :|

    • alSeen says:

      I know, I think universal health care should be extended to universal housing as well. thousands of Americans die every year because they are living on the streets. We should force everyone to pay in so that we can build houses for those poor unfortunate people.

      • digital0verdose says:

        It’s OK not to live in a world of extremes. Letting gay people marry doesn’t mean that people will legally be able to marry their dog next, regardless of what Fox News tells you.

        • TuxthePenguin says:

          True, but how can you justify banning polygamy if you’ve already allowed gay marriage?

          Marriage has traditionally been one man, one woman. We’ve now rewritten one part, why not the other?

          (This coming from someone who doesn’t give a damn what you do in your relationship. Seventeen people want to get married? I’m all for it. I just hope you’re ready for the divorce proceeding when one of those people wants out…)

          … back on topic, though…

          How about we actually have insurance systems rather than the prepaid medicine we have now? Heck, either go that way or go full universal coverage. This half-breed system we have now and the bastard half-breed system we’re about to have are worse than either end of the spectrum.

          • pandroid says:

            I believe there was a study a couple of years ago that compared the incidence of political/social instability to the rate of polygamy and polygamy didn’t come out looking good for stability. Basically, gay marriage doesn’t take more of one gender off the market than the other. Polygamy tends to take more women off the market, leaving lots of unhappy straight dudes (at least in current times when most guys live to the same age as women). Those unhappy dudes start trouble/overthrow the government. This is all from memory, though, so I could be totally wrong.

          • digital0verdose says:

            Traditions are based on the knowledge and logic of the times. As things progress, so should traditions.

            That said, this is a legal matter. One that has big financial and legal implications. If marriage should stay man and woman, then all tax breaks and legal matters that such a joining is followed with should no longer take place.

            If that is not acceptable then the opportunity to marry person with similar legal rights should be permitted.

            I’m not aware of too many dogs that would be capable of uphold their “partners” DNR rights or financial matters.

            • alSeen says:

              You are the one that mentioned dogs. Tux only mentioned polygamy.

              Every argument for gay marriage is also an argument for polygamy.

              The same arguments can also be made for marriage between siblings or parents and offspring (as long as all parties are of legal age).

              • Gulliver says:

                What would be wrong with that? Consenting adults can marry whomever they want. animals can not give consent. By the way, until Lawrence V Texas it was illegal to commit sodomy (oral or anal, male and female) with a human, BUT as of today it is still legal to fuck a horse in many states including Florida.

        • alSeen says:

          I can understand how you would think that I was talking about gay marriage and Fox news. After all, every other word in my comment was “gay” or “fox.”

          • digital0verdose says:

            If you don’t see the correlation between your comment and my comment about marriage, well I am not sure how much more clear I could make it, but I’ll try.

            Being extreme is silly. You were being extreme. I was being extreme in my comment to highlight how your’s was silly.

      • tbax929 says:

        Yeah, that’s totally the same thing.


      • PunditGuy says:

        Spend too much time in the vicinity of concrete and you just die? I didn’t realize that the streets were so dangerous. Or did you just pull that stat out of an orifice?

      • Skankingmike says:

        It’s called, HUD, section 8 and in my state we have COAH, Coalition on Affordable Housing.

        It’s a state right to have affordable housing in NJ. Meaning that if a town has new development of any kind commercial or residential, the developer/s must build low/moderate income housing.

        It’s not a horrible concept but like everything good in this state it became corrupt.

        But yea believe whatever you want i guess.

        • alSeen says:

          I’m fully aware that there are government programs to assist in housing.

          That is a far cry from the government being responsible for providing everyone with housing.

      • AnonymousCoward says:

        I know you’re being sarcastic, the Bush administration, believe it or not, had an experimental program where they took long term homeless people off the streets, and just gave them a place to live. It turned out that it was actually cheaper to just give them housing than it was to pay all the costs of their homelessness (jails, emergency rooms, etc).

        So yeah, maybe universal housing is a good idea. Just like universal health care.

      • craptastico says:

        tell me again why i work hard? it’s not to pay for someone else’s housing. i have a hard enough time paying for my own. another government handout is not the solution.

    • Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

      The only way to go… universal health care. Take the for profits out of the equation.

      Washington tried to fix the terminal patient (health care and insurance costs) with a band-aid. Just like the “fix” for credit cards, the companies found a way around it.

      Example: new rules require that any company that offer child – only health insurance insure those with pre – existing conditions. The insurance companies response? “We don’t sell child – only health insurance anymore”

      Cue Red from “That 70’s Show”: Dumb Ass.

      • TuxthePenguin says:

        I’ll say this and say it simple.

        If you wait until you are sick to purchase insurance – you are not purchasing insurance. You’re just making someone else purchase it.

        That’s why we had to have an individual mandate with the “reform”. Insurance only works if the entity running it takes it enough money to cover all expenses that need to be paid. That includes overhead for administration, etc. BCBS is non-profit… yet they are one of the worst out there.

        • shockwaver1 says:

          Yes, because insurance never gets rescinded for “pre-existing conditions” that are complete bullshit.

          And because it’s easy to insure children who may have been born with a “pre-existing condition”.

        • crashfrog says:

          “If you wait until you are sick to purchase insurance – you are not purchasing insurance. You’re just making someone else purchase it.”

          Agreed, but if you wait until someone makes a claim to investigate their account for fraud, you’re not selling insurance, you’re stealing.

          The profit motive has to be taken out of the system, because the incentives run in all the wrong directions. Companies that can rescind coverage on the basis of “undisclosed pre-existing conditions” (conditions that the policy holder may not even be aware of, or may not even have!) have every incentive to collect premiums for years and then cancel coverage at the first claim. Individuals who can buy insurance regardless of pre-existing conditions have every incentive to buy in the back of the ambulance.

          There’s only one solution, and that’s mandatory health insurance for everybody – administered either by the government, or by government-regulated private companies. Of course, that won’t stop the teatards from pining for the days when you could pay thousands of dollars a year and still not expect any actual coverage.

    • SiddhimaAmythaon says:

      Its a balance thing. My sister in in the UK and i am here in states so i have personalty seen both sides of this. The only issue that i see is the a government system seems to get easily overbooked. If i want to see a doctor or dentist i can have an appt in 72 hours or less . Unless shes in pain its months for a checkup or a cleaning for my sister.

      • RadarOReally has got the Post-Vacation Blues says:

        But unless she has pain, why is it a problem to wait months for a cleaning?

      • myCatCracksMeUp says:

        I’ve got a fantastic dentist, actually a group of 7 dentists and numerous assistants and hygienists, and I have to wait for four to six months to get a cleaning or checkup appointment. If I miss a scheduled one, they’ll try to get me in sooner, but my appointment will be 4 to 6 months from when I ask for one. But they get me in quickly for an actual problem.

        This situation with your sister is NOT one that indicates a problem with Britain’s system.

      • SolidSquid says:

        Strange, I’m in the UK and the only case where I’ve seen that being an issue is when someone has *very* restrictive requirements for when they can make it to an appointment (eg, only after 4:30 due to work commitments). Most of the time if you’re able to take a day off (and I’m pretty sure sick days are required to cover this) then you’re fine for an appointment. Maybe your sister should look at switching practice? It sounds like they’re the ones causing the problem if they’re taking in too many patients

      • pdj79 says:

        How is this scenario any different than what we have here in the States? When it comes to routine checkups and cleanings, those are scheduled well in advance…at the last checkup or cleaning, which is a year and 6-months, respectively. I usually don’t see my doctor for anything accept well visits because if I am sick or in massive pain to the point where a doctor is needed, he’s either on vacation or completely booked and their suggestion is to go to the emergency room or immediate care facility. In all actuality, I’ve only seen my actual doctor a handful of times in the 14 years I’ve been going to him. The rest of the time it’s other doctors in the practice or nurse practitioners drawing blood and taking readings.

        I’m not saying a “socialized” government-run healthcare system would fix anything or make things worse….there’s not enough evidence either way to really compel me to pick a side of that argument. But I will say this….the one thing that I hate most about seeing a doctor is the bullshit red tape I have to go through to make sure my visit is marginally covered by my insurance…if at all. I understand it’s for their protection from fraud and there will be people on Consumerist that will tell me that it’s for the best to have these precautions. But these are the same people who scream out that a business like Walmart or Best Buy should NOT be treating all their customers like criminals, subjecting them to ID verification for credit card purchases, receipt checks, or even covert surveillance as you walk out of the store to your car. Why should my insurance company, who I pay a massive bi-weekly premium to and yet only use the coverage once — maybe twice a year, treat me as a potential fraud artist from the onset and try their hardest to deny my claims, going so far as to claim my doctor, who is part of a health group that my insurance is accepted at, is suddenly out-of-network and that my procedure (a routine follow-up after removal of a benign tumor that was, I might add, not fully-covered because it wasn’t medically necessary to remove) was not eligible for coverage with an out-of-network doctor. To add to the anger I have for my provider, 3 weeks later I had my annual physical with the same doctor….guess what? It was covered!!!

    • benh999 says:

      Thank you for my queue [sic]. Beyond bureaucratic glitches, I would cite:
      1. The preponderance of free and low-cost medical care provided to the poor in the US.
      2. Our superior quality of care. How many Americans go to other countries for healthcare that can not be provided here? How many Canadian surgeons perform surgery via remotely controlled robots on patients physically in America?
      3. That most Americans (including me) are better off with their current private insurance than they would be in other countries with nationalized healthcare.
      4. In countries with nationalized healthcare that physicians can opt out of, many do and are frequently patronized by those who can afford them.
      5. Few, if any, government-run agencies provide a remotely acceptable level of service. Certainly, the nit-pickers on consumerist would not tolerate their healthcare being run in the same manner as the USPS (our President’s comparison), the DMV, or the IRS.

      • dbeahn says:

        Few, if any, government-run agencies provide a remotely acceptable level of service. Certainly, the nit-pickers on consumerist would not tolerate their healthcare being run in the same manner as the USPS (our President’s comparison), the DMV, or the IRS.

        So explain to me then why it is that there are so few complaints on the consumerist about government services, but dozens about privately run business daily?

        • dolemite says:

          Those systems actually work pretty good in my experience. You might not like the hassle, but our mail system is one of the best and cheapest in the world, the IRS does a great job of doing what it is supposed to do: collect taxes, and the DMV does what it is meant to do. I think our healthcare system would probably end up being pretty decent too, and certainly better than our current broken mess where you pay insane premiums every month, then have to complete an insane yearly deductable, and when you finally go to the doctor, you have to fight them tooth and nail to actually cover anything.

          • winnabago says:

            I agree – the USPS has never stopped me from trying to mail a letter with them. However, their hours are something else entirely…

      • c_c says:

        “Our superior quality of care. How many Americans go to other countries for healthcare that can not be provided here?”

        Apparently a lot more than you think. “High quality care” don’t mean squat if you can’t buy it:


        • benh999 says:

          That is my point. Americans travel to other countries for more common procedures at a lower cost. Non-Americans travel here for advanced procedures that don’t exist or carry much higher mortality rates elsewhere.

          I would rather dump my life savings and run up a huge debt in order to get a life-saving medical procedure for me or a member of my family than not have it available at all.

          • dolemite says:

            I guess that’s the difference. A lot of people choose to just die rather than saddle their family with hundreds of thousands in debt, and wipe them out entirely. “Ok, guys, I’m alive, but we are bankrupt. So…sorry kids, no college for you, and beenie weenies for everyone for the next 50 years! Hurray! Guys….guys??”

      • c_c says:

        “Few, if any, government-run agencies provide a remotely acceptable level of service. Certainly, the nit-pickers on consumerist would not tolerate their healthcare being run in the same manner as the USPS (our President’s comparison), the DMV, or the IRS.”

        My wife works at a government run hospital, and I’d say they provide much better than just an “acceptable level of service”. They provide excellent service. Do you think all hospitals/clinics are privately run now? Not even close. And a huge portion of healthcare in the US is already administered by the Federal Government (Medicare/Medicaid) … do you really think the private sector would pick up that slack if it didn’t exist? Nope.

        also, I prefer USPS to FedEx and UPS, their rates are cheaper and I’ve never had a problem with lost mail. Also, I’ve never waited more than 45 minutes in a DMV… I’ve waited longer in line in my privately owned dentist’s office.

      • Cheap Sniveler: Sponsored by JustAnswer.comâ„¢ says:

        Yea… I AM ONE who had to leave the country to get medical and dental care overseas. Cheaper and done by doctors FROM THE SAME COUNTRIES as the doctors here in the USA…

      • El_Fez says:

        That most Americans (including me) are better off with their current private insurance than they would be in other countries with nationalized healthcare.

        Congratulations on being able to afford having insurance. Me, I’m unemployed and therefore on the “Don’t Get Sick” medical plan.

        • RadarOReally has got the Post-Vacation Blues says:

          It’s ok. As long as he’s covered, that’s all that matters. If you lose your job, then your insurance due to a ridiculously archaic system where the two are tied together, then you obviously deserve to die, and to suffer along the way.

          But, hey, most people are ok.

      • Loias supports harsher punishments against corporations says:

        Regardin #2, wow!!!! I would LOVE to be in a country with doctor’s SO GOOD they can actually perform surgery via remote control robots to less fortunate countries like the U.S.

        Sounds snarky, but I’m serious. Clearly Canada is the better system if they can do these things and Americans are asking for them.

      • RadarOReally has got the Post-Vacation Blues says:

        Also regarding #2, google “Medical tourism”. Then come on back.

      • megafly says:

        What’s wrong with the USPS? They provide service to almost every residence in the country and do it for less than 50 cents?

        • coffeeculture says:

          cuz they lose money doing it and could require taxpayer intervention.

          their tracking systems are horrible…i just pony up for UPS if it’s that important. USPS is for post cards and random certified mail items.

      • Gulliver says:

        BUT, current and former military personel ARE covered under a SINGLE PAYER GOVERNMENT FUNDED system. It is also the highest rated health care organization in the US, as rated by its users. Try again.

      • Conformist138 says:

        1. I live in a no-man’s land of being too poor for even the most basic coverage, but I haven’t spit out a kid yet so I don’t qualify for anything at all- no help with food or rent, no medical help, nada. And the free or low-cost care? I see elderly and sick people queuing up outside of shabby and poorly stocked free clinics and they wait as long as it takes, maybe all day, just to see someone who still may not be able to do anything.

        2. Medical tourism. To Mexico and Centeral/South America. So yeah, US citizens DO go to other countries for care because it’s so absurdly expensive up here.

        3. Lucky you. See #1, I can’t get jack shit. I work full time in a job that can’t be done by bratty teenagers or even most college students (due to scheduling), so I can’t even lean on mommy or daddy’s insurance. The company I work for wants to charge their $9/hr wage slaves a MINIMUM of $350/mo for the most basic coverage. That’s 30% of my net monthly income and we’ve not even counted the co-pays and deductible. Also, I have a friend who has survived cancer 3 times. The last time he was no longer on his parents insurance- he had to go get a job while undergoing treatment to make sure he was still insured. He was forced to specifically work for the state (where his dad works) because no other insurance company will take him anymore. Literally, he had to work 40+ hours/wk in a high-stress job just to keep paying for his own chemo. If anyone deserved to just take it easy, it’s this guy. He even was forced to beg for donations of his co-worker’s vacation time before he could dip into his medical leave. He was going on leave in order to have cancerous bone removed from his skull. What do you have to bitch about that would be SO terrible if there was a national system that didn’t make the sickest people beg and work themselves even sicker?

        4. GOOD! The system works, then. Some doctors opt out and the rich people spend more money on them. Fine, who cares? The doctors that are in the national system are not poor and living in poverty, they’re comfortably middle class and most are OK with that. So, richy-rich gets to pay a premium for a doctor and the rest actually get to see a doctor. Right now, ONLY people able to pay out the ass get care. So, again, what is such a bad thing about a national system?

        5. The US ranks #37 in the world for health care. I won’t research all of the countries above us, but many of them off the top of my head I know have national systems. Notably, France is #1 and they have a public/private mix. Italy is #2. Even Canada is ahead of us at #30. We *barely* beat Slovenia and Cuba.

        So, there’s all that… anything else?

      • myCatCracksMeUp says:

        The preponderance of free and low-cost medical care provided to the poor in the US.

        You’re so very, very wrong.

        If you’d done the tiniest amount of research you’d realize that there are millions of poor people who cannot get the medical care they need.

        I know some of them, and it is very sad to see.

    • nybiker says:

      Queue vs Cue.
      Cue: To give a cue to; signal or prompt. (http://www.thefreedictionary.com/cue)
      Queue: People waiting on line. (http://en.wikipedia.org/wiki/Queue). Or, in computer systems, the printer queues (the list of files waiting to print).

      So, cue all the other people to comment on this as well.

      (And, yes, there are other meanings to the words, but I am just pointing out the basic differences).

      • dolemite says:

        Perhaps there is going to be a long line of Rush Limburger idiots waiting to talk about how private insurance is awesome, just because they happen to work at one of the few remaining employers that actually have good insurance. So there will be a queue.

        • guroth says:

          The people who are covered by or benefit from private insurance will say that the system works. The people who are not covered from private insurance will say that the system is broken.

          I can’t help but notice that the people who are putting into the system are the ones benefiting from it, and the people who aren’t… aren’t.

      • Mike says:

        That’s funny, it was a total Freudian slip. Between my imagining in my mind the long line of people waiting to throw in their “you socialist” comments, the fact that I am an IT guy and talk about queues all the time, and my being educated in the British system, I was destined to use “queue” as apposed to cue.

      • OnePumpChump says:

        I’m sure they’ll be queueing up, on cue.

  2. Tim says:

    Wait, so the plan doesn’t cover any flu vaccines? That’s crazy.

    I’m glad she got it anyway and paid out of pocket. It’s only $25 or so, right? And don’t be too afraid of The Cooch. He’s still got a job to do, you know.

    • Marlin says:

      No, it covers all Flu Vaccines are covered by your plan.*

      * All vaccines that are approved are covered, none have been approved at this time.


    • Nigerian prince looking for business partner says:

      It’s not that crazy. My health insurance doesn’t cover any vaccines unless I’ve already hit my deductible.

      For those with a standard PPO, vaccines can be treated like any formulary — some are covered, some aren’t, and some are different prices.

    • Rectilinear Propagation says:

      I’ve seen it higher at $35 but nothing crazy expensive.

    • Nigerian prince looking for business partner says:

      This is pretty much the reason I like my HSA/HDHP plan.

      I know that it wont cover anything until I hit the $2,500 deductible. There’s no stressing about whether a particular inoculation will be covered. I may have to pay $25 out-of-pocket for the flu shot but my family saves about $400/month in the process.

      • Tim says:

        The HSA/HDHP plan my employer is probably switching to next year would cover flu vaccines, annual checkups and some other small preventive things, 100%, not subject to the deductible.

    • Difdi says:

      The plan covers all flu vaccinations up to $500, but only if you use a vaccine that is on the approved list. Unfortunately, someone didn’t put any on the list…

  3. DanRydell says:

    “If anything should be covered by health insurance, it should be a freaking flu vaccine!”

    While I agree that it should be covered if they say it’s covered, this sentence here is illogical. Inexpensive things like flu vaccines are the things that we don’t really need insurance for. It’s the expensive stuff that costs tens or hundreds of thousands of dollars that most people can’t feasibly pay on their own that we really need insurance for.

    • Loias supports harsher punishments against corporations says:

      Or, my health insurance premiums should include the miniscule cost of a flu vaccine. It’s like getting free coffee at the auto mechanice while you wait: it costs the auto shop practically nothing compared to the cost of the main work they do, but goes a long way toward customer satisfaction.

      • DanRydell says:

        You say “or” as if you’re saying something that is at odds with what I said. Did you read my comment? Perhaps, but apparently you didn’t understand it.

    • Anathema777 says:

      Well, yeah, but flu vaccines are cheaper than flu treatments for health insurers too. You’d think it would be in their best interest to keep the people they insure as healthy as possible.

      • wrjohnston91283 says:

        It makes financial sense for a health care plan to cover things like a flu vaccine or a simply checkup. Not insurance. I can afford a $25 vaccine. I can’t afford a $25,000 stay in the hospital if I get sick. We should be insuring against the cost of the expensive items, not routine checkups.

    • AnonymousCoward says:

      Under the health reform bill, flu vaccine is covered for free starting next year. Except for a few loopholes, of course…

    • KyBash says:

      Because of government-mandated paperwork, the cost of processing the claim is probably close to $100, plus the dollar amount of the claim.

      Small things like this belong in the plan’s deductible — save your receipts, and if/when you meet the deductible that year, it can be processed in one swell foop, saving everyone money.

    • OnePumpChump says:

      Cheap things that only affect YOU should maybe not be covered.

      Cheap things for preventing infectious diseases should be free.

  4. TuxthePenguin says:


    By its very nature insurance should not cover vaccines. The entire concept behind insurance is that you are paying a small amount now to hedge your risk about some larger payment in the future. IE, if there was a 1% chance you’d have a condition that required a payment of $100k, you’d be willing to pay $1k to offset that risk every time it came up. If it was a 2% chance of $100k, you’d be willing to pay $2k… getting the point? The insurance company wants a bit more to hedge its own risks (and cover admin, etc), so you pay a premium for the coverage. Yes, that’s where the word comes from.

    Insurance is for risks you cannot easily control. That’s why we call it insurance The flu shot… you are entirely in control. You do realize that by covering these sorts of things, we’re wasting money giving it to the insurance comapny. There is a 100% chance that you will face a $50 charge. But the insurance company wants an extra 10% premium… so your $50 charge is now $55.

    /rant off

    • K-Bo says:

      But, if I’m told if you pay this price, you get flu shots, I still expect to get flu shots. They can’t say I’m paying for one thing, and deliver another.

    • Etoiles says:

      Right, but “health insurance” in this country isn’t actually straight-up insurance the way car insurance or homeowner’s insurance is. It’s more like “right to access health care in 98% of its forms.”

      • Sepp_TB says:

        Wouldn’t it be fun if it were though?

        “I see you filed a claim because you got the flu. Did you you get a flu shot this year? No? Well… we are denying your claim because you did not preform proper routine maintenance and are negligent.”

        Health ‘insurance’ in the US really needs to be called by its real name, a ‘Health Plan’. It ceased being insurance long ago, and the closest thing left are various high deductible plans.

    • cvt2010 says:

      I think I see your problem… You’re trying to apply logic to the health insurance argument! What people seem to expect isn’t really health insurance, it’s free health care.

    • Tim says:

      I see it quite differently.

      As an insurance company, you want the people you insure to be as healthy as possible. That way, you can avoid a lot of the major expenses. So why not encourage customers to be healthy by providing them with the tools that allow that … like preventive vaccines. The $25 flu vaccine is cheaper than, say, a course of Tamiflu (I know, not everyone takes Tamiflu for a normal seasonal flu, but you get the idea).

      • TuxthePenguin says:

        Then in that case you offer rebates for preventative medicine, healthy lifestyles, etc. If you help the insurance company manage their risk (ie, flu shots, not smoking, etc) then they’ll reduce your premium.

        You know, how insurance actually works. See auto industry.

        No, we don’t have “health insurance.” We have “prepaid medicine”.

        • GuidedByLemons says:

          Gotcha, they should cover preventative care through a cumbersome bureaucratic process that will discourage customers from actually getting said care, instead of just covering preventative care.

          You seem to be hung up on the word “insurance”. Health care is a fundamentally different animal from auto collision repair and liability, and there’s no reason a health plan should act the same way as auto insurance simply because you’re persnickety about the dictionary definition of the word “insurance”.

    • IThinkThereforeIAm says:

      While you may have a point, there is the other side… for the interest of the Insurance Provider:

      Instead of waiting for you to get sick (and having to pay a usually much heftier price) they could just use preventive care (as far as I know HMO stands for Health Management Option – that is they should be managing your health for a monthly/yearly/bi-weekly fee) for a lower cost per person. I’d say that’s probably a better business plan – especially in the case of the flu, which is a fairly common ailment.

    • EverCynicalTHX says:

      I tend to agree with Mike,

      Insurance was never designed to cover all the little things and if it does many will abuse the system while others like myself foot the bill.

      This is why Obamacare is such a poor idea and why well over 50% of the population opposed it and still do..

      Sadly, that made no difference to those idiots currently in control of congress as they rammed it down our collective throats.., sigh…

    • Fubish says: I don't know anything about it, but it seems to me... says:

      Uhhh… no. Health insurance is also for preventive medicine. You know: so you DON’T get sick and the insurance company has to pay larger medical bills. This has been a facet of all decent insurance plans for many years.

      • wrjohnston91283 says:

        That’s what health care plans are for. Somehow, over the past 50 or so years, health insurance turned into health care, but for some reason, we’re still calling it insurance, which is what it is not. Think about your homeowners insurance. Insurance requires many people to pay a small premium each month in insure them against future unexpected medical expenses, and in turn, a small portion of those people get their hospital bills taken care of when they get unexpectedly sick. However, if I have diabetes, its a GIVEN that I’m going to have medical expenses in the future. You can’t insure a given.

    • davein805 says:

      The underlying problem with this posting is that we are talking about insurance when we should really be talking about this being a case of indemnity. TUX is correct about insurance but what we have here is a matter of indemnity masquerading as insurance. In any event, I side with OP. UHC/Medco should cover the flu vaccine as a preventative and actually as of 9/23/2010, the Affordable Care Act mandates the coverage. The trick with the mandatory coverage is that you have to have to implement a new or renew a group health plan for it to be covered. Otherwise you are grandfathered under your current plan until renewal time.

    • GuidedByLemons says:

      There’s a gaping hole in your logic: when your insurer is on the hook for catastrophic coverage, it is in their best interest to encourage you to avoid catastrophic health problems like severe complications from influenza. Let’s do some toy math:

      Suppose 5% of people who don’t get flu shots get the flu, and 5% of those people who get the flu have catastrophic complications averaging $10,000 in covered expenses. Then every flu shot saves the insurer $10,000 * .05 * .05 = $25 in covered expenses. If providing flu shot coverage doubles the number of their customers who actually get one, they’re saving $25 / 2 = $12.50 in covered expenses for each flu shot they cover, and they can afford to provide that coverage for as little as $50 – $12.50 = $37.50 for a $50 vaccine.

      This is to say nothing of negotiated discounts that allow insurers to pay for drugs more cheaply than individuals paying out of pocket, nor of employers who want to encourage their employees (on employer-provided health plans) to stay healthy so they don’t lose productivity.

    • dolemite says:

      You are correct by strict definition..that is what insurance is for. HOWEVER, an insurance company would be better served paying for preventative medicine. For instance…if they paid 50% of my gym membership, they might save themselves 200K down the road when I need heart surgery. 12k in gym fees they cover, vs 200k. They cover flu vaccine now, they save me a doctor’s visit and 3 prescriptions later.

      • catastrophegirl chooses not to fly says:

        yep, my insurer publishes their cost-benefit analyses on their site so i can see exactly where they decided that my medical device [$1500] and the monthly medical supplies to operate it [$500] are cheaper than the average number of nights spent in the hospital to treat diabetic complications that the device helps prevent.

    • Liam Kinkaid says:

      Actually, the “very nature” of the insurance industry is to maximize profits. So, while you paint a rosy picture about hedging your risks against a nebulous future occurrence, insurance companies have absolutely no problem with dropping you in a heartbeat the very minute they learn that you’ve contracted a very expensive illness.

      Further, the insurance model prices itself so that even having coverage is very expensive. The insurance industry lobbied employers to provide at least some of the cost to employees, making it affordable for the workingman. Of course, after you’re above working age and, consequently, more prone to have more expensive healthcare needs, the government takes care of you with medicare. This is what’s known as “privatizing the profits, socializing the costs.” This, and the aforementioned practice of recission, is what allows insurance companies to rake in billions of dollars of net income. In order to minimize the impact of seeing these very large numbers, they present this as a common-sized number, as a percentage of revenue. “Oh, we only made 4 1/2% profit last year. We’re hardly making *any* money,” they cry. I could just spit.

    • PsiCop says:

      Re: “Insurance is for risks you cannot easily control.”

      Unfortunately, the costs of a case of influenza are not necessarily that easy to control. In a lot of cases the cost is very little … a person is sick for a while, but gets over it. In other cases the costs are much higher, especially if the person is very old, very young, or has some other problem that is compounded by the flu.

      Hence, lots of insurance companies have offered to pay for flu shots. Some of them have run the numbers and determined that it’s not a poor investment. It’s not new … some insurance companies have been doing it for a long time.

    • katstermonster says:

      This isn’t about whether the vaccine should be covered (I disagree with you, but I see your point), it’s about the fact that United Health Care SAYS they cover the vaccine, but they actually don’t. It’s about bad business practices and outright lying. Whether or not they should cover it at all is a totally different issue.

    • Verucalise (Est.February2008) says:

      I’m confused by your rant… although you make sense, where I live– Insurance companies are paying out the WAZOOOO for “preventative care”- vaccinations, gym memberships, lowering premiums for people considered ‘healthy’. Are these insurance companies hoping by preventing a major sickness/catastrophe, they are gaining an edge on the hedge? LOL

  5. PhilFR says:

    “If you get a flu vaccine, what steps do you take to make sure you pay as little as possible for it?”

    Use last year’s vaccine. Much cheaper!

    • BobOki says:

      This years vaccine IS last years strand and does NOTHING to keep you from getting sick. Each strand is totally different from each other and have no bearing to each other in any way except the name “flu”. It is just like car computers, they each have one but very very few can work in another car… this is no different.
      Flu vaccines are a waste of time and money. Note, this is NOT the same as getting your baby shots and saying it causes autism…. that’s just stupid.

  6. RadarOReally has got the Post-Vacation Blues says:

    This is very common. I have top-of-the line medical insurance, and I have to pay for my flu shots. I pay $25 or $35 each year. Since I have to pay anyway, I just have my doctor do it and pay out of pocket.

    It’s silly, but her outrage is pretty hilarious. It’s not just her particular carrier.

    • RadarOReally has got the Post-Vacation Blues says:

      P.S. I do agree that they shouldn’t have told her it was covered if it wasn’t.

      • RadarOReally has got the Post-Vacation Blues says:

        P.P.S. And I don’t try to cheap out on it. It’s a small price to pay to not get the flu, be out of work, have to pay copays for doctor visits and medication later on. Just pay it and be done. (If you truly can’t afford it, I think there are various programs out there. If you can, stop yapping and suck it up.)

    • tbax929 says:

      It shows how wildly coverage varies from plan to plan. I have United Health and haver never, ever paid for a flu shot.

      I don’t think I’d be all that bothered if I had to pay for it, since it’s a minimal charge, but I’ve never had to.

      • Nigerian prince looking for business partner says:

        Either way, you wind up paying for the flu shot. If you have a very good PPO that covers those kinds of things 100%, you’ll just pay higher premiums for the privilege of doing so.

    • dolemite says:

      I’d rather just get sick, and send them the bill for $500 worth of services/prescriptions than pay for it out of my own pocket.

    • LuckyLady says:

      All plans are different. My plan has a deductible that has to be met for items like durable medical equipment. So when my 19-month-old was prescribed an inhaler, which had to be used with a spacer, I had to pay for the spacer out-of-pocket. That went against my deductible. When I had to get her a nebulizer, that also went against the deductible.

      I’m betting that this would be something that would also be applied against a deductible.

      I never skip a flu shot. I’ve found it’s a lot easier to just go to a cash clinic, pay my $25 and get it over with, rather than file on insurance for the flu shot.

  7. mtwmtw says:

    Try this, have them contact UHC not Medco because an immunization is actually a medical benefit, not a pharmacy benefit. Sounds like they are calling the wrong party.

    • levenhopper says:


    • Quantumpanda says:

      The pharmacy has no choice but to bill Medco, as they administer the pharmacy benefits for pretty much all UHC plans. There is literally no way for the pharmacy’s online adjudication system to bill UHC directly. If she went to a doctor’s office, they would bill UHC instead of Medco, and there would probably be no problem.

  8. tackhouse1 says:

    I don’t know the specifics of Claire’s situation, but up until last year I had United Health Care (now with a different provider). Like Claire my UHC insurance covered flu shots and I got them covered 100% every year. In my case, the shot was covered directly by UHC, not by my prescription provider

    I received flu shots both from my Doctor, and from a Pharmacist, having no issue with coverage in either case.

  9. Macgyver says:

    Getting a flu vaccine is a load of crap.
    I’ve never gotten a flu vaccine, and I never got the flu either.

    • Veeber says:

      I’m glad your singular anecdote can be the definitive answer for all.

    • johnrhoward says:

      Yeah, I’ve never worn a condom, and I never contracted HIV. Condoms are a load of crap.

    • Loias supports harsher punishments against corporations says:

      How do you know you never got the flu? Have you never been sick? I assume you have gotten flu/cold-like symptoms at some point, and since doctor’s don’t routinely test for the flu I imagine you don’t actually know you’ve never had it.

      Not everyone responds to illness the same – some get very sick, while others get only mild symptoms. A mild flu is still a flu.

      And since when is your one single instance the basis for an entire medical doctrine? So you’ve never had the flu. Does this mean no one gets the flu? Does this somehow negate the statistics of influenza cases before and after a vaccine?

      I think not. Your personal experience does not somehow create a basis for comparison.

    • You Can Call Me Al(isa) says:

      The only time I got the flu (since I can remember) was the one year I got the flu shot my freshman year of college. I won’t be getting the flu shot again.

      • Anathema777 says:

        It sounds like you’re drawing a false correlation from your experience. The flu shot can’t give you the flu since it contains a dead virus (though, like any shot, there can be potential side effects). But you can certainly get the flu even after getting the shot because there are so many strains of the flu and the vaccine only protects you against the one that people predict will be the most prevalent.

        • You Can Call Me Al(isa) says:

          I do realize that the flu shot didn’t cause the flu I got that year. But still, I didn’t get the flu any of the years I didn’t get the shot.
          I know a lot of people will argue that I am protecting others by getting the flu shot, but I’ll stick to the traditional ways… sneezing into my shoulder, washing my hands, and staying home when I don’t feel well.

          • Anathema777 says:

            Okay, cool; thanks for clarifying! A lot of people do think that the flu shot causes the flu, so I just wanted to try to kill that myth.

            • You Can Call Me Al(isa) says:

              Yeah, I don’t always do a very good job typing out exactly what I mean. I sometimes look back and think: “I sure could have said that better.”

          • HogwartsProfessor says:

            Doing your preventive actions like washing your hands, etc. is probably a big factor in why you didn’t get the flu. If more people did that, less people would get it.

      • Loias supports harsher punishments against corporations says:

        I’m agreeing with Anathema, and adding that you wouldn’t think this way if you talked to your doctor about it or read up on the issue. Your doctor would correct you straight away.

        Please, don’t get health opinions based on poor research or a complete lack of research.
        The same attitude made many think health reform would create Death Panels.

      • RadarOReally has got the Post-Vacation Blues says:

        I’m so tired of hearing this. Were you actually tested for Influenza? Were you tested to see if it was a strain your vaccine contained? Or did you just get a virus that year and assume you got it from the flu shot?

        Be ignorant all you want, but it’s not nice to spread that myth around and scare people who really need it, like those of us who are immuno-compromised.

        • You Can Call Me Al(isa) says:

          As I stated below, I do realize the shot wasn’t the cause of the flu I got that year, but that doesn’t make it a false statement. I got a version of the flu the same year I got the flu shot.
          My doctor has never suggested that I, personally, get the flu shot.

    • cmdr.sass says:

      I carry around a magic rock that prevents bear attacks. So far so good!

    • craptastico says:

      you’re right. i never got a vaccine for Martian smallpox either, and guess what? i’ve never gotten it. all vaccine’s must be a scam by that logic

    • White Scorpion says:

      I’ve never had a flu shot either. I’m 62 and never had the flu and don’t want to take a chance with the vaccine. My son is 40, never had the vaccine and is never sick. We avoid crowded places to decrease the possiblity of catching something, so it’s easy for me to boycott Walmart.

  10. keepntabs says:

    When the new Health Care Bill went into effect last week, preventive care such as flu vaccines, mammograms, and colonoscopies are covered under everyone’s health insurance, and is not subject to co-pay or annual deductible requirements. The changes to your health plan are effective when any plan you have selected during your next open enrollment. For many people, that means an January 1, 2011 effective date.

    I am unsure if I would have voted for the bill if given the opportunity, but since it is in place it will be helpful for a lot of people who were not getting this type of care because of insurance policy exclusions and/or the out of pocket costs. These changes will undoubtedly may the price of health insurance rise across the board and may make it unaffordable for a lot of folks, but I am also of the opinion that a few extra dollars spent now will save lives and millions of dollars later on.

    • Tim says:

      The preventive care provision doesn’t apply to plans that started before the law passed (and no, a new year doesn’t count as a new plan).

      • AnonymousCoward says:

        Yes, there are loopholes with “grandfathered” plans. But with the way health insurance costs are going up, companies are changing plans as fast as they can to find cheaper ones. I don’t think the grandfathering clause is going to affect too many people for very long.

      • Loias supports harsher punishments against corporations says:

        Yes, yes it does. All health plans must provide free preventive care as of last week, and all company-run style plans go into effect after their next enrollment period and the new insured period begins. In most cases, this is 1/1/2011.

        RTFB (Bill).

      • keepntabs says:

        Your are partially correct. The bill doesn’t affect your current health care plan, and if your company doesn’t have an open enrollment period this year or it doesn’t change the health coverage offerings for the employees, then your plan will not be affected. However, most people get their health care insurance through an employer, and most employers only have annual agreements with the health care insurers, because they want to maintain flexibility to look for better deals each year. Also, most employers want to give their employees the opportunity to change coverage if their needs change or they are dissatisfied with a particular carrier. Even if you do not elect to make any changes to your health care plan, the mere act of holding an open enrollment constitutes a new health care coverage for your employer, and the preventive care rules will be in effect when the new policy is activated. Congress was very aware that most companies have open enrollment periods during the last quarter of the year, and that is why I think they made sure the bill was effective before the end of September.

    • Loias supports harsher punishments against corporations says:

      I don’t see how providing a $25 vaccine will skyrocket health care costs. I pay more than that pay period. Even if they raised my insurance $25/year across the board…..wait, they do that every year anyway…it wouldn’t hit me that hard.

      And others made the point – making your payers healthy means less cost to you. It’s in their interest to provide preventative medicine.

    • Nigerian prince looking for business partner says:

      The thing is, nothing is free. “Free” preventative care is only free, so far as our premiums will go up to cover the “free” care. This is the reason why HSA/HDHP plans are so much cheaper than traditional PPO plans.

      I’d much rather have lower premiums if it means paying for these types of things out of pocket. As it is, I pay $800 month for my family’s HSA plan. If I wanted a lower deductible, free preventative care, low copays, etc. , I could upgrade to a PPO for $1,200 a month.

      I’d much rather pocket the difference and apply it towards future deductibles.

      • Tim says:

        HDHPs are not immune to the preventive care provisions in health care reform. They’ll have to cover things like annual visits and flu vaccines.

  11. Mike says:

    This is a deceptive business practice, they can’t say the cover flu shots and then not cover any available vaccines at all. If they deny your claim, tell them you’re going to file a fraud complaint with the state attorney general, and that your next step will be contacting Pomerantz Haudek Grossman & Gross LLP, who already won a class action lawsuit against them. At issue is that you signed up for coverage from United Health Care in part because of the promise of 100% coverage for flu vaccines.

  12. Interesting says:

    I haven’t gotten a flu shot since I was in school and it was required. I’ve also not had the flu since I was in school.
    eating right, not going out with wet hair, avoiding being out in rainy days [when possible] keeping your hands washed and having as little contact with people who already have the flu but came to work anyway is a few ways to keep from getting sick in the first place.
    Almost everyone I know from friends to my grandparents only get the Flu if they get the Flu shot.

    There is my 2 cents

    • unchainedmuse says:

      Get the flu shot, get the flu! See, it works!

    • SunnyLea says:

      I’m not taking health care advise from someone who thinks you get the flu from going out with wet hair, thanks.

      And I work with the public, so, sadly, avoiding sick people isn’t really an option. Which is why I’ve gotten a flu shot every year since I was 16 or so. Have I gotten the flu? Yes. Happens. But only a few times.

      The flu vaccine *cannot* cause one to get the flu. It’s dead virus (okay, except for the nasal thing, but that’s fairly new and uncommon).

    • armchair lactivist says:

      Colds and the flu are NOT caused by going out with wet hair or on rainy days. If it were, the entire cities of Seattle and Portland would be constantly sick with the flu.

      Exposure and a weakened immune system lead to the body fighting off the flu or a cold.

  13. ShruggingGalt says:

    >United HealthCare

    There’s your problem right there.

  14. jbandsma says:

    Luckily, my pulmonologist gives his patients flu shots at no charge. Strange doctor, he’d rather keep us well than have to admit us to the hospital.

    But my insurance has a really strange way of doing things. They call and urge women to get mammograms and assure them that the test won’t cost them anything. And that is the absolute truth…the TEST doesn’t cost anything. But they don’t pay for a doctor to read the results. Which can be anywhere from $300 to $800 depending on where you have it done and who reads it.

  15. gnarsky says:

    point blank – if your insurance provider states to you plainly that you should be covered by something and you are not, there is a MAJOR problem. Whether they should or not or how much is really far from the point in this case. They said it was covered, so they should cover it. What’s so hard to understand about that?

    in this case it may be a $20 flu shot, but I can see this same scenario happenng with $100k surgeries just as well.

    I have good insurance and rarely have to “fight” with them on anything – but this situation would certainly upset me on a fundamental level. Is it akin to starving children in Haiti? no. But, it feels fraudulent.

  16. Sunflower1970 says:

    So, she has coverage for the flu vaccine, yet no flu vaccine brands are covered….yeah. That’s some great logic right there…

  17. Liam Kinkaid says:

    They just don’t want you to get autism. You’re welcome.

  18. Phexerian says:

    Pharmacist here.

    Ok. UHC says it is covered so it may be covered. However, it may not be covered at a pharmacy. Pharmacies do not bill directly to UHC. We are required to go through PBMs (pharmacy benefits managers) which is MEDCO (PAID is another name for MEDCO as well).

    I am not familiar with Rite Aid’s pharmacy software so I don’t know what their “Rejection” said but all of the flu vaccines I have tried to bill through MEDCO this year have come back and told me the patient needs to file a manual claim with the insurance company.

    Pharmacies bill PBMs via an NDC (National Drug Code) number. All vaccines are considered drugs and have an NDC. (eg. Fluvirin and Fluzone are vaccines but have two different NDCs)

    UHC might pay for the vaccine at a physicians office but not at the pharmacy. That is a possibility as we bill through MEDCO and a physicians billing is different from our own. If UHC is saying that they cover flu shots it may have to be given at your physicians office.

    But, most likely it sounds like you will have to file a paper claim with UHC to cover it.

    As far as other posts…

    @ C4andmore and OP – Don’t ask your pharmacist to call UHC directly. He won’t do it. We only deal with MEDCO and having him call UHC won’t get anything done as pharmacies don’t bill UHC. They bill PBMs which then turn around and bill your insurance company what we billed them plus a fee.

    @Tux – I disagree with the thought process that vaccines should not be covered on insurance. They prevent illness and prevent people from visiting the physician which costs money, and also saves money on the prescription end, as well as other secondary costs such as time, gas, and lost wages. This is why Medicare and some state Medicaids pay for flu vaccines because they realize in the long run it saves money. This is why a good many private insurance providers cover vaccines as well.

    Unfortunately, insurance in the US is unbelievably complex and very difficult to maneuver through, even for pharmacists and other people skilled and handling insurance complications.

    • Tim says:

      So should the OP pay out-of-pocket and file a claim for reimbursement? Would the claim be valid, or is the issue that she can’t get them at pharmacies and needs to get them at a clinic instead?

      Also, shouldn’t UHC tell MEDCO that it covers flu shots?

      • Phexerian says:

        I would suggest the OP call UHC and make sure they will accept a paper claim. if so then yes, get it and file the claim.

        I’m sure MEDCO knows that UHC covers flu shots, but MEDCO probably refuses to allow billing for it through pharmacies. Why is this? I honestly don’t have a clue why. That’s internal between those two companies and I don’t have access to that information.

  19. PineTree says:

    Does Virginia have an insurance comissioner? If so, please, for the sake of the rest of us file a report!

    I dealt with a very similar issue with Oxford/UnitedHealthCare and it took filing a complaint with the state insurance comissioner and complaining to the insurance broker to get it resolved (Issue was similar – something allegedly covered but not available in practice witiout paying out of pocket). Ultimately, they paid me back but then sent me a snotty letter saying they only did it because they are nice people and not because they had to. As an insurance lawyer myself- though not in health insurance- I call BS on that one, Insurance companies don’t pay things they don’t have to pay.

  20. Rectilinear Propagation says:

    If you get a flu vaccine, what steps do you take to make sure you pay as little as possible for it?

    I get it done at work because my employer actually pays for us to get one. So I pay $0 by being lucky.

    Saying that they cover flu shots when they don’t cover any particular brand of flu shot is just BS. The OP should also let HR know that she had this problem since coverage of preventative medicine, like flu shots, is probably part of the reason her employer picked up this plan. They’re thinking they’ll have fewer people getting sick but then people are waiting on the appeals process instead of getting the shot.

  21. DoctorMD says:

    My auto insurance will not pay for preventive care for my car (new tires and brakes) to prevent a future accidents or homeowners replace my roof to prevent future fire damage. Health insurance is no longer insurance, really hasn’t been for years and after the Unaffordable Care Act doesn’t even resemble insurance. So you don’t have to pay $25 for the flu shot but your “insurance” is now $30 more expensive to cover it. Added administrative costs and profit is why insurance makes no sense to cover expected incidental costs, it will end up costing you more in the long run.

    I am sure if an insurance company or government run system evaluated the numbers they would not cover the vaccine. The odds of a young healthy person needing expensive care for the flu is extremely small. On the other hand they would cover it for elderly or people with specific health issues as a hospitalization and ICU stay are much more likely. If anyone should pay for your vaccine it should be your employer, they have the most to lose if you do get the flu.

  22. quieterhue says:

    I think people are missing the point here.

    We can argue all day about whether or not insurance companies should cover flu vaccines. The issue here is that Medco claims to cover flu vaccines, but there are no brands in existence they will actually pay for. That’s deliberately being deceptive (or just incompetent). That’s not acceptable.

    Thankfully, this happened with an item that Claire could afford to pay for out of pocket. What if this was a much more critical and expensive medication, such as heart or diabetes medication? You buy a plan thinking your particular needs are covered, and then you find out they are not until it’s too late. Not OK.

    • katstermonster says:

      Marry me??? :)

      I’ve been reading all these threads getting so annoyed that people are missing the point entirely. If Medco doesn’t want to cover the flu vaccine, that’s a whole other issue, but they shouldn’t say that they do! It’s not that hard to understand, people!

      • Rectilinear Propagation says:

        Have you noticed that the way that the annoying comments are annoying tend to follow trends? It used to be all the rage to blame the OP for shopping or doing business with a certain company in the first place but you never see a thread where over half the commentors are doing that anymore. Now it’s popular to tell the OP that their problem isn’t a big deal and they’re just whining.

  23. krom says:

    The next time her plan comes around for renewal, flu shots will be required to be covered by health plans under the Affordable Care Act laws.

  24. alternety says:

    Same thing with Aetna Medicare. And the shot recommended for >65 years old was $57. Wife on medicare got same shot; no questions asked or fee collected.

    • alternety says:

      It may be an issue with getting the shot at a pharmacy. They check drug coverage. This may not be viewed as a drug for some no doubt very strange reason.

  25. lovemypets00 - You'll need to forgive me, my social filter has cracked. says:

    I’m going to CVS tomorrow. It’s $29.99, and I won’t have to make a doctor’s appointment, pay them the office fee copay, plus whatever they charge for the shot. It’s much cheaper and more convenient to go to CVS.

  26. DjDynasty-Webology says:

    I catch HIV, and the state gives them to me for free anywhere in the state.

  27. JuliB says:

    Good grief – man up, sister! I wouldn’t have bothered trying to get mine covered. I did the frugal thing (no – I didn’t make up my own batch at home) – I saw a special deal at CVS where if I spent $30 on selected items (those I bought I use and need), I got the vaccine free.

    I would save your complaining for a real problem.

  28. myCatCracksMeUp says:

    I absolutely love the sentence: . If I had a decent attorney general I would email him, but sadly I live in Virgina and our AG is insane.

    That is so true. I live in Virginia and hang my head in shame over our AG.

  29. meg99 says:

    Why couldn’t she just get this from her doctor? I’m not understanding why this is the subject of an article.

  30. crazedhare says:

    SO par for the course with UH/Oxford/Medco. As soon as I saw their name pop up, I knew how it was going to be.

  31. mdoneil says:

    What does an attorney general have to do with a flu shot?

  32. Cycledoc says:

    Interesting comments. Should a health plan, even a “top of the line” one cover absolutely everything?

    How should a health care system control costs?

  33. Michael A. B. says:

    I have some experience with this. This sounds like the OP may be speaking with the wrong people about the wrong thing. Most prescription plans do not cover flu shots as they are covered under the medical plan. My suggestion would be to submit a claim to UHC for direct reimbursement. If it is denied, I would suggest filing an appeal based on what you were told prior to obtaining the shot.

    If that does not work, report it to the Bureau of Insurance as a complaint. The state AG has nothing to do in something of this nature. The BOI would have jurisdiction here.

    Talking to Medco isn’t going to get you anywhere as they are likely only to cover items that are covered at the point of sale.

  34. baristabrawl says:

    Isn’t it like $25?

  35. FrugalFreak says:

    “I have a good insurance plan”

    I beg to differ.

  36. armchair lactivist says:

    Medco is as shady as prescription companies come! I went through a 45 minute phone ordeal related to why my $0 copay went to $80 with no warning, and after the Medco employee “investigated” it for me, I was told it was because a generic is now available.

    I have no issue with generics in theory. But I’ve tried the generic for my particular medication, and ended up with all sorts of side effects (racing pulse, incredibly high blood pressure, dizziness). Without telling me, Medco overrode my prescribing doctor and said the generic is effective for everyone, and would not grant my appeal to have the name brand covered.

    I love my health insurance company (Premera) but absolutely HATE Medco!

    • tailspin says:

      did your doctor write “no generic substitution” on the prescription? unless he or she did, it’s common practice to switch it with the generic if that’s what’s covered. nothing shady there at all, the same thing would happen if you went to a retail pharmacy to fill it. i have the same issue with one of my meds and i make sure my doctor writes that every time i need a refill… it costs more than the generic, but at least i know it works.

  37. crazydavythe1st says:

    Aetna told me the same thing. Actually, they told me I could pay out of pocket, or I could pay a copay to see a doctor and have them administer it.

    I figure I’ll just have them pay the hospital bills if I get this year’s swine avian mega flu. I’m overdue for some sick leave anyway.

  38. drburk says:

    My regular shot was covered at the counter. When I got my regular H1n1 they said it may be covered but that they weren’t able to submit it for me I had to do it on my own. I took this as look, we are making big money off this (I waited 1:30 for my shot) so why waste man power to earn less money.

  39. ospreyguy says:

    I have medco and my whole family gets the vaccine every year… Odd.

  40. John Gage says:

    Before we chastize the insurance company, I think it would be important to know if this plan is self insured or fully insured. If it is self-insured, the OP’s employer could have decided not to cover the vaccine.

    • brinks says:

      That’s a good point. I had Anthem/Blue Cross Blue Shield at my last employer and they (the employer) decided not to cover proton pump inhibitors as a cost-saving measure. I have Anthem again at my current employer, and they’re covered.

      However, that’s no excuse for the fact that no one can give her a straight answer.

  41. skapig says:

    All that you have to do is call ahead and check to see that you will be covered. The plans do pick-and-choose where and what they cover. Your pharmacist can easily check (ease depending of course on the insurance company’s level of nonsense that will have to be waded through).

  42. dennis says:

    In Panama the hospital workers come to my house with the vacine, no charge. Ain’t it great to not live in such a poor country as the US.

  43. Thorzdad says:

    We found out the hard way that, with insurance companies, “covered” does not mean “paid for.”

    My daughter had to have a series of vaccinations two years ago when she was starting college. We knew the group of vaccinations would be pretty expensive, so we contacted our insurer (Anthem) to see if the shots were covered. The CSR on the phone assured us that, absolutely, the vaccinations were covered 100%. Additionally, our doctor’s office offered to double-check to really make sure. They got back the same information…vaccinations were 100% covered on our policy. Those were Anthem’s words…”100% covered.”

    After the vaccinations, we got a bill from our doctor for around $400 for the vaccinations. WTF??? So, we got on the phone to both Anthem and the doctor. The gist is that, when Anthem says “100% covered”, all they mean is that the vaccinations weren’t disallowed. It did not mean that they would pay anything toward the vaccinations. Rather, 100% of the costs would be applied to our deductible. At not ime in all of the conversations either we or our doctor had with Anthem was this point mentioned.

    We scoured our policy to find the relevant section dealing with this, but never could find anything specific to vaccinations.

  44. elscottosgirl says:

    I experienced the same thing tonight at Walgreen’s here in Texas. Not too long ago I saw a sign in their store that said if you have United Health Care, you can get a flu shot there for free. I should have gotten it that day. I went in tonight and they charged me $29.99. WTH is up with that??? I guess, you snooze you lose. It makes no sense to me that they wouldn’t cover the cost of a flu shot.