So i made an appointment at Walgreens to get an RSV vaccine. I got there, and they said they couldn’t bill my insurance.
Does my insurance not cover it (in which case I’m willing to pay) or does it just not cover it here?
That proved to be a difficult question. The person i reached after calling my health insurer said they cover it as preventive medicine, and Walgreens is their main distributor. I could also go to Walmart, Costco (neither convenient) or a bunch of places that don’t do business in this part of the country. CVS, which is the other major pharmacy chain, is not a provider they cover.
But Walgreens was unable to run the claim. “That’s a hospital card, it doesn’t have the codes a retail pharmacy needs.” They kept trying to run my drug insurance (through caremark, not UHC) which didn’t work. But there simply aren’t the codes on my UHC card for them to enter anything into the system.
I just wasted an hour there. I literally gave my phone to the pharmacist so she could talk directly to the insurance woman.
Sigh.
It’s an expensive vaccine ($300) and I’d really prefer to get it covered by insurance.
FYI, here is a gift link to a New York Times article about how other people (particularly those without a Medicare Part D plan) are in the same boat as you.
Sorry to hear about your trouble. That is what happens when you are the first person ever to try to get an RSV vaccine from Walgreens with UHC and Caremark. It’s never happened before in the history of time, and nobody knows how to deal with it.
I’ve had similar problems when I’ve tried extremely rare things with my insurance, such as transfer a prescription from the hospital pharmacy to Caremark mail order, which Caremark has now made a requirement of my plan. I’m pretty sure none of the other 36,000 people who work in the same university system as me have prescriptions. They are all very healthy, or just use lavender oil.
Now that my insurance requires me to use Walgreens I’ve discovered some things. Not all stores are equal. If one store can’t do something, another one may be able to. The pharmacies are constantly operating short staffed, and the hard working employees can’t keep up.
The Walgreens website lies about things. The main Walgreens page may say a pharmacy is 24 hours, the store page says it’s open until 10, but in reality it closes at 7. See the short-staffed bit.
I probably AM the first person to try doing it at this particular pharmacy. And they took my information and said they would ask the technician who is good at these things tomorrow. (The insurance lady kept asking “do you have a pharmacist who knows how to do this” and the pharmacist kept indignantly replying that she was a pharmacist. I admit, I didn’t realize that pharmacy school was all about how to deal with insurance and corporate software.)
The pharmacist wanted to keep my insurance card. I said she was welcome to photocopy it, but she couldn’t (wouldn’?) do that. Ultimately, she wrote down all the numbers.
Sigh.
I just wrote my doctor (who is based at a hospital) and asked if the hospital can give me the shot. I’m pretty sure they know how to bill UHC.
That’s a slightly different boat. The article says that lots of plans have chosen not to cover it. My plan HAS chosen to cover it, it’s just that Walgreens can’t figure out how to submit the claim.
I mean, in theory, I am in a better position than people whose plans won’t cover it at all. But it’s a more frustrating position, because I feel like if a just do the right things, they’ll pay. If there was no coverage, I would decide to pay or to skip the shot and be done, either way.
hmm, maybe. I never do that, and wouldn’t know how. But it probably is possible. But… the fact that they cover the vaccine from some providers and not from others makes me suspect that wouldn’t be easy.
I’m in the same boat trying to get one for my daughter who in ICU for seven weeks with RSV last year. If there ever was someone who should have her RSV vaccine paid for its her (even on purely mercenary financial grounds), but likely they won’t.
That said every single interaction between healthcare providers, insurance, and pharmacists results in the kind shitshow the OP describes (and she has a lot as she has complex medical needs), so at this point I’m used to it.
There’s a lot of that in play, isn’t it? It’s like the insurers have figured out how to have their cake and eat it, too: openly state they’ll cover things, but make it impossible to submit a claim.
In the case of the pharmacy, the most important knowledge isn’t Pharmacy Science, it’s Insurance Systems. (Many, since every insurer will have completely different and uttlerly inscrutable hoops to jump.)
Her situation sounds incredibly frustrating. But if she recently had a documented case of RSV, it’s not clear she would benefit from the vaccine. Has she talked to her doctor about it?
I kinda want the vaccine because i haven’t been exposed to anything since covid, due to hiding and masking. So I’m afraid my immunity to ask the common stuff has waned, and I’m looking for whatever vaccines i can get (flu, RSV) to catch up.
You probably need a new DTaP shot as well, whooping cough is making a comeback.
My latest COVID shot was delayed due to UHC/medicare/social security issues and for some reason they wouldn’t let me self pay. (I was planning a trip to visit my 87 year old mother, I wanted to be fully vaccinated. I was able to go to a different pharmacy and tell them I didn’t have insurance so I could self-pay.)
I called UHC and got some one who sounded like she knew what she was doing, but as it turned out, she didn’t. I called back again and am ashamed of the fit I threw, but I needed that shot. If you call them, they do take case notes, but they don’t read them and want to start all over from scratch each call.
While all of that bullshit was going on, they also decided to cut my pharmacy coverage off all together which was a really good way to blow my blood pressure to the moon.
The good news is that I did find out how to submit a claim for everything I had paid for but certainly did not pay me for the time and frustration involved.
Good, I wasn’t until I heard about women in my social group coming down with whooping cough and I didn’t want to go along with the crowd. Measles is also an up and coming thing out this way as well.
Thanks, it did get straightened out and I got paid less than a month after I filed my claim. That’s actually why I posted, to tell you that you will get paid if you are persistent enough.