Let Patients Help, Cost-Cutting Edition: the shingles vaccine
This is cross-posted from the original on ePatientDave.com. Many comments were posted; I’ll paste in the most important at bottom of this, including the “smoking gun” proving that shingles vaccine is covered (is required to be covered – since 2006!) by all Medicare Part D (prescription) plans.
Two months ago I posted Let Patients Help, Cost-Cutting Edition, part 1: a bill:
I often hear about how patients are a major part of the cost problem – their “non-compliance,” their wanting everything they can get, wanting it for free, etc. So, let’s see what happens when a patient who wants to help cut costs gives it a try. …
In that case I tried to fathom a so-called “Explanation” of Benefits, which was in fact unfathomable. (The FTC forced cigarette makers to be truthful in labeling; can’t they force insurers to stop using “explanation” on something nobody understands?)
This time my wife and I are shopping for vaccines. Specifically, shingles. And trying to be a responsible consumer turned out not to be easy.
Shingles (herpes zoster, aka chicken pox) is a nasty condition that develops sometimes in elders who had chicken pox as a kid. (Wikipedia: “The immune system eventually eliminates the virus from most locations, but it remains dormant… in the ganglia adjacent to the spinal cord … or the ganglion semilunare … in the base of the skull.”) When it awakes, it is nasty painful – my mom had it for months this summer – and there’s not much of anything you can do. You just suffer, until it’s damn good and ready to go away.
And I mean suffer. It’s debilitating. Mom’s cropped up as she was recovering successfully from otherwise-uneventful hip replacement surgery(!) … apparently it’s not uncommon for this to happen when one’s system is challenged, e.g. by surgery.
There’s a vaccine, and it’s recommended for everyone over 60. So my wife and I decided to get it. (Nothing like a close family member with a recent horror story to get you in gear.)
But guess what: the vaccine is wicked expensive – at least $200 – and Medicare doesn’t cover it! Update 1/10: Medicare “Part D” (the D-for-Drug/prescription supplement) does cover it, but a lot of people don’t know that – including people who work for Medicare! See my comment tonight. Nor does AARP’s supplemental insurance. That’s Medicare “Plan N.” On the other hand, my private insurance – the New Hampshire high risk pool – does cover all immunizations … but there’s bureaucracy. Here’s what we found – a collection of anecdotes:
- My mom said a local grocery store’s clinic offered a deep discount if you fill out a long questionnaire. Not available here.
- My uncle in Atlanta got a verbal approval from his insurance before he & wife got it – then the claim was denied anyway, saying “Well, what that agent told you was wrong.”
- I called my plan, NHHP, and got a verbal okay. I called again, got a different agent, got a verbal okay. Called two weeks later, got another one. Went to Walgreen’s yesterday,which advertises it, and they said “Your insurance doesn’t cover it.”
- Called the insurance company today (they’re not open weekends), and learned they cover it but only at the provider’s office, not at a pharmacy (What??) I’ve found a really good guy at the insurance company to discuss things with, and I told him I again want to do some comparison shopping.
- I said “You still won’t cover it at the pharmacy, even if it’s more expensive at the doctor?” They said yes but only if I pay for it and submit the paperwork. How long will it take to get reimbursed? They don’t know – “It might not be very fast.”
- In an earlier episode I’d learned they don’t keep info on which providers offer the best price for various things. I suggested they offer it – chances are pretty good they do have some historical data, and should publish it!
- I called Walgreen’s and asked the price: $220.
- Called my hospital (Beth Israel Deaconess) to inquire about their price.
- Main switchboard didn’t know what a shingles vaccine is or where to get prices; referred me to my provider’s office. (No problem.)
- They referred me to the travel clinic.
- Travel clinic said they don’t do it anymore – it’s now in Infectious Diseases.
- Infectious Disease clinic charges $298. Or, $209 if you pay in full at time of service. And btw, they only offer shingles vaccine on Tuesdays. (What??)
- I’ve been excited that Dartmouth-Hitchcock, a great quality organization, is opening a new facility near me next week. So I called them, and their price is … hold your breath… $360 plus $44 “to stick the needle in your arm.” Yes, $404. (She said they make Medicare patients sign a special waiver saying they realize it won’t be covered.)
- 1/10 update:
- When we got the bill from Beth Israel Deaconess today, we saw that the $298 is $235 for the vaccine and $65 to stick the needle in your arm.
- Meanwhile today on a concall I heard (just grapevine) that Dossia.org is offering client companies information about, for instance, the prices for all the local MRI shops. That is a wild idea – offer us comparison shopping data. Woot.
All in all, my wife is assessing whether it’s worth the cash. Like everyone in this economy, we have plenty of concerns about cash.
- Update 1/10: I convinced her she’s worth it – and thentoday we found out that Part D does cover it. (How many people skip the vaccine because they were told it’s not covered??)
Whether it’s worth the cash was Mom’s concern, too, as she postponed it for years, until it was too late.
- Update 1/10:
- But now, it appears she could have had it four years ago: Part D plans covered it starting in 2007 (see this post on the AAFP site).
- Now this is pissing me off: this screw-up cost my mom months of agony, lost sleep, pain, exhaustion, a ton of family work caring for her, and pain, and suffering. All because this industry is such a disgusting, disorganized, misinformed mess that needed information doesn’t reach the people for whom it was created. For years!
Here’s what I want: Let Patients Help, and that includes controlling costs. Don’t you dare say we don’t care about healthcare costs, if you make it hard for us to shop. Please – help us help! Give us the information!
And please, insurance, when we find something cheaper, accept it…??? Let’s put an end to this malarkey of “Gosh, costs went up – we had to raise our premiums.”
p.s. Flu vaccines:
- Walgreens: $32
- Beth Israel Deaconess: free, in your provider’s office
- Dartmouth-Hitchcock: $46-$56, plus $44 to stick the needle in your arm
Twitter buddy @Health311 adds this short PDF. It’s a three page memo from May 2006 (5-1/2 years ago!) with this opening sentence:
“As you know, Part D plans are required to provide access to vaccines not covered under Part B.”
Then @Kari_On added: “Medicare RX plans must cover all commercially-available vax (i.e. shingles vax)http://1.usa.gov/zndUdu,” which includes this:
Part D Vaccine Coverage
Except for vaccines covered under Part B, Medicare drug plans must cover all commercially-available vaccines (like the shingles vaccine) when medically necessary to prevent illness.
And @TheMedDiva added a post on her site about how hairy it is to figure out the real rules: “today I posted “Yes Virginia (and ePatientDave), the shinges vaccine really is covered under Medicare Part D”