silly question about school.immunizations anx paying for them?

[wannabeny]

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.

[KRVRN, BSN, RN]

Does your college have a health clinic?

[wannabeny]

Does your college have a health clinic?

unfortunately they do not.

and i checked; the pcp im going to isnt affiliated with a hospital.

how would i find a hospital lab, would i just walk into any local hospital in my area and find the lab? i wouldn't goto the ED right?

[DowntheRiver]

I work in a UC/Occ Health clinic here in Central Florida. All vaccine and titer costs must be covered up front. 90% of insurances don't cover vaccines as adults unless it is Td, TdaP, Shingles, or Flu, and even then there is probably a co-pay. The reasoning behind this is that most adults are not exposed measles, mumps, rubella, or Hepatitis B as an adult. Usually, and of course there is always exception, the people most at risk for contacting these diseases (aside from rare outbreaks, needle sharing, etc.) are healthcare workers. Therefore, usually the burden of cost falls on the individual who seeks higher education and/or employment in a healthcare setting. Most schools and companies have account cards set up with specific clinics which will give you a significant discount on the cost of immunizations, titers, TB tests/TB chest x-rays, and physicals. For instance, a TB test is usually $40 at my clinic OOP but for most schools/employers it is $11 OOP. I would just pay OOP and since you're lucky enough to have a rare insurance that covers those items submit them for reimbursement.

If you went to school in Florida, more than likely you already have these vaccines unless you had a medical or religious exemption. Florida has a shot database called Florida Shots! which more than likely has your updated vaccine information on it unless you're older. If you've had these vaccines, you probably just need titers to show immunity. No need to get vaccines which you already have, or don't need updated until later in life.

[nutella, MSN, RN]

For the PPD - if there are retail urgent care offices etc check with them. Here in my state they do all kind of preventative stuff including PPD and it is much cheaper than anywhere else!

[cherryelle07]

You can also contact the high school you graduated from. I was able to get my shot record from my school as they still had it on file.

[wannabeny]

i did pull my HS records (im 28).

yes, i need titers for MMR and Varicella (i had it as a kid).

Hep B I believe i had one dose as a child.

My tetorifice expired as of last year.

I was led to believe they would be covered. Unfortunately I can't pay $350 worth of testing with my other expenses at the moment.

[cherryelle07]

Your Td should be covered. I got the TDap and it was covered, so your Td should be covered. You will probably have to re-do the Hep B series. It's weird they won't bill insurance for it, because we do here at the clinic I work at and billing will just bill the patient for whatever insurance doesn't cover. If you've confirmed with your insurance company that they will cover it, then I don't get why its a problem.

So how does your PCP do labs, cultures, and bloodwork for his patients? Does he/she use an independent lab?

[wannabeny]

she uses a lab for blood work, but i spoke to them and they dont offer half of what i need and they don't do titers. i dont want to be running around looking for somewhere to get everything done.

i don't get it either. and i havent gone to any pcp/, lab, etc that isnt in my in-network providers.

it clearly states in my guidelines that 100% of the cost of those vaccines (minus ppd) are covered.

i did call a hospital near my house today, its not the same county as where my pcp is, but i told them about the orders she gave me, they said i should be fine. guess i'll find out tomorrow!

that or im taking a $350 advance on my check :/ ugh

[NutmeggeRN, BSN]

You can also contact the high school you graduated from. I was able to get my shot record from my school as they still had it on file.

Because some awesome school nurses save EVERYTHING!!!! Also check and see if there is an Occ Health dept , they may be able to help.

[DowntheRiver]

Titers are never going to be covered. I'm just trying to prepare you for this. If this is, for instance, for admission to clinicals for nursing school then 100% health insurance will NOT cover it. Why? Because there is no medical or health reason for you to get titers at this time other than needing them for school.

I seriously believe you're going about this the wrong way. Again, I live in Florida. My clinic services not only the schools in the area but as well for most of the state. I'm very familiar with titers, vaccines, and necessary paperwork for entrance to many healthcare programs. What exactly does your form say you need? Like, the exact phrasing? Some places let you opt out of Hep B but you have to sign a waiver.

[wannabeny]

I can opt out, but they told us we needed it to get into clinical.

I explained to Premera that the immunizations were for school; i was told by several people and supervisors that they are covered regardless. immunizations & titers are covered 100%, no deductible by my insurances' exact words. and exact wording in the paperwork sent to me.

I need the immunizations before I can start the program period. (and I do appreciate your insight. This is a cost I wasn't expecting up front.)

It says I need:

-Tetorifice shot if over 10 yrs since my last one

-Flu Vaccine (this is a must. The school won't let us attend clinical)

-Rubeola and Rubella or the titers. (I had MMR vaccs as a kid, 2 of them)

-Hepatitis B (there is a way to decline, but they can't guarantee a clinical spot.)

-Varicella or titer (i had it as a child)

-ppd skin test(mandatory) or chest x-ray if positive

[NurseGirl525, ASN, RN]

I guess things are different up north. We just go to the hospital to get these done, not some outside clinic. I think your issue is you are bringing up insurance issues before they even bill. Just give them your insurance card. They should just bill you. Most of mine were covered. My flu vaccine is covered 100% every year. I have never paid for a flu vaccine.