silly question about school.immunizations anx paying for them?

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Ok..so I am going through the procesd of getting my physical and immunizations for nursing school, and i need the following:

ppd test

tetorifice

flu

rubella/rubeola or mmr

hep b

varicella

my insurance, whom i have called twice, covers ALL except the ppd. they say it is preventative care.

im kind of frustrated (AKA alot frustrated) because my PCP has sent me out to do the vaccines.

Everywhere I have called, they refuse to just bill my insurance, they want upfront out of pocket expense for all of them, even though all of them are in-network providers for my health coverage,

why is this? Even the insurance reps I spoke to couldn't understand why they wouldn't bill them, and tried to call on my behalf.

anyway, my PCP wrote me these.lovely blue paper script things, with lots of lovely security features, with her signature,my name, and what vaccines/titers i needed.

is that like a doctors script, since she couldn't do them at her office? the walk in by me said if i have a doctors script or order that i wouldn't pay upfront, so im just wondering of thats what they are.

i haven't had a shot since,oh, 10 yrs ago, and just got insurance 2 yrs ago, so excuse my ignorance. :(

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

Typically for children, vaccines will be covered but not usually for adults for MMR & Varicella. Not all clinics administer vaccines, as some are frozen, others refrigerated and staff have to know correct storage & administration of vaccines. The same for PPD test. Not all clinics administer them. Staff must know how to administer & interpret results.

Usually your childhood vaccine record is needed to determine if you need more vaccines or if you need titers drawn. Titers check to see if you still have immunity. Which is why your PCP wrote out a script for you.

You are probably being told by clinic staff that vaccines are not covered for adults because they usually are not by commercial insurance and medicaid will not cover these either. It is preventive if you are due for a vaccine such as Tetorifice which boosters are recommended every ten years, so this one your insurance company may cover. It is typical to get a combo vaccine of Tdap (tetorifice, diphtheria, pertussis) as there have been cases of pertussis where grandparents passed on pertussis to a newborn.

You might be able to get re-imbursed by your insurance but you will need to submit forms.

TB tests can run around $40. Ballpark figure.

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Check with you state health department.

Mine provides all those vaccinations and the PPD.

Vaccinations are $15 each.

Not sure about the cost of the PPD.

You can then submit the insurance forms yourself and get re-imbursed.

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To add to my comment above -

checked our state health department web site - if your insurance is one of the ones accepted, they will actually file a claim with your insurance company for you. You only have to pay and then file the insurance yourself if they don't accept your insurance.

My experience has been that the health department is the cheapest place to get vaccinations and TB testing. Reducing communicable diseases is their mission.

They charge enough to cover their costs, but they don't need to make a profit.

They also frequently get grants to help defray vaccination costs.

Other states are probably different, but it wouldn't hurt to check with your state dept of health.

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Typically for children, vaccines will be covered but not usually for adults for MMR & Varicella. Not all clinics administer vaccines, as some are frozen, others refrigerated and staff have to know correct storage & administration of vaccines. The same for PPD test. Not all clinics administer them. Staff must know how to administer & interpret results.

Usually your childhood vaccine record is needed to determine if you need more vaccines or if you need titers drawn. Titers check to see if you still have immunity. Which is why your PCP wrote out a script for you.

You are probably being told by clinic staff that vaccines are not covered for adults because they usually are not by commercial insurance and medicaid will not cover these either. It is preventive if you are due for a vaccine such as Tetorifice which boosters are recommended every ten years, so this one your insurance company may cover. It is typical to get a combo vaccine of Tdap (tetorifice, diphtheria, pertussis) as there have been cases of pertussis where grandparents passed on pertussis to a newborn.

You might be able to get re-imbursed by your insurance but you will need to submit forms.

TB tests can run around $40. Ballpark figure.

Yes, my insurance covers all of the above vaccines/titers, they consider them preventative, with the exception of the ppd test.

Yeah, they told me i would get full reimbursement for the vaccines and titers. I did have MMR as a child, and i think part of the Hep B series.

does the script mean i would not need to pay out of pocket? just confused on that part...not sure why i would need a script if places want upfront payment.

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Check with you state health department.

Mine provides all those vaccinations and the PPD.

Vaccinations are $15 each.

Not sure about the cost of the PPD.

You can then submit the insurance forms yourself and get re-imbursed.

i checked with my local health dept, they wouldn't take adults :/ those are cheap for the shots! my area the cheapest shots are $35-40, mostly $70+

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Specializes in critical care, ER,ICU, CVSURG, CCU.

Your script for the vaccines, are "just an order" for vaccine needed....

It has nothing to do with re-imbursement, it is just a doctor's/ or mid level practioner's order

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Specializes in PACU, pre/postoperative, ortho.
i checked with my local health dept, they wouldn't take adults :/ those are cheap for the shots! my area the cheapest shots are $35-40, mostly $70+

Can you check with the health dept of a neighboring county? I've found that they all do things differently. I had to have an MMR booster for school when I found out I only had one round as a child & was not immune to rubella. My own county HD did not offer the adult MMR, but I was able to get it in the next county.

Also prices can vary between HDs; the 2-step ppd was $20 each time ($40 total) in my county, but was $10 total for another student a couple counties away.

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My TDAP shot was covered through insurance. We did it at the clinic I work at and we just billed insurance. We bill insurance for everything, but PPD screenings and work/school/sports/camp physicals. One step PPD screenings cost $28 at my clinic. It's $56 for a two step. Not sure where you live, but it's pretty standard to bill insurance for vaccines here.

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florida. it isnt so standard here apparently. just very frustrating

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Specializes in ICU.

So, if your doctor can't do them in her office, why are you not going to the lab at the hospital? Your Pcp should be affiliated with a hospital. The hospital will not make you pay up front. Just go to the lab and give them your orders and insurance. They will bill and what isn't covered they will bill you for.

I think what you are trying to do is go to an outside lab. Don't do that. Just go to your local hospital lab, preferably the one your doctor is affiliated with. They order labs for people everyday. I'm surprised your doctor didn't tell you which one to go to. And don't go in and discuss with the lab what is not covered. Their billing dept will take care of that.

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So, if your doctor can't do them in her office, why are you not going to the lab at the hospital? Your Pcp should be affiliated with a hospital. The hospital will not make you pay up front. Just go to the lab and give them your orders and insurance. They will bill and what isn't covered they will bill you for.

I think what you are trying to do is go to an outside lab. Don't do that. Just go to your local hospital lab, preferably the one your doctor is affiliated with. They order labs for people everyday. I'm surprised your doctor didn't tell you which one to go to. And don't go in and discuss with the lab what is not covered. Their billing dept will take care of that.

i didn't ask her about hospital affiliations but i will now. i asked her where i could go in order to get the shots done, and she didn't offer any suggestions beyond a minute clinic or urgent care.

if i go i to a hospital do i just say i need lab work completed and i have insurance?

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