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?