Insurance Vent, Wouldn't this save money?

[DawnCt1]

Flu shots with our insurance plan are covered 100%. No copay, etc. The caveat is that they must be given in a participating physicians' office. Most physicians take our plan. It is SO much easier however to stop in at the many pharmacies, Costco, etc that are offering them and get one, however, they will not reimburse. Seems like it is far more convenient for the consumer and less costly for the insurance company, that they would want to do it that way, but nope.

 

[golfgal]

I don't see at as being any different to stop in the dr's office vs CVS or wherever. If we go to the dr's office for a flu shot we don't see the dr, we don't really even need an appointment during flu shot hours, just stop in, fill out the paperwork, get a shot just like we would at CVS or wherever.

 

[tlbwriter]

I don't see at as being any different to stop in the dr's office vs CVS or wherever. If we go to the dr's office for a flu shot we don't see the dr, we don't really even need an appointment during flu shot hours, just stop in, fill out the paperwork, get a shot just like we would at CVS or wherever.

Not all doctor's offices work that way. Mine definitely doesn't. For me, it's MUCH less convenient to go to the doctor's office, and it also means a nurse who would normally be dealing with sick people is spending time on me instead, which results in longer waits for the sick people.

 

[ccgirl]

It involves contracts. The insurance companies have contracts with doctor's offices and not with pharmacies (other than prescription specific). Giving a flu shot is not considered medication (prescriptions), rather an office visit. Hope this helps.

When you see the dr, your insurance will send you an EOB. On there will be the total cost of the visit as well as the price the visit was contracted with the insurance company. The price difference is written off and cannot be charged back to the patient.

 

[DawnCt1]

It involves contracts. The insurance companies have contracts with doctor's offices and not with pharmacies (other than prescription specific). Giving a flu shot is not considered medication (prescriptions), rather an office visit. Hope this helps.

When you see the dr, your insurance will send you an EOB. On there will be the total cost of the visit as well as the price the visit was contracted with the insurance company. The price difference is written off and cannot be charged back to the patient.

Clearly it does involve contracts, but if I were writing contracts, I would find a way to limit costs and let patients access the most convenient and AFFORDABLE means to a vaccination. I take DS to the local pharmacy when he comes home from college Thanksgiving break.

 

[mjkacmom]

Not all doctor's offices work that way. Mine definitely doesn't. For me, it's MUCH less convenient to go to the doctor's office, and it also means a nurse who would normally be dealing with sick people is spending time on me instead, which results in longer waits for the sick people.

Same here. Our pediatrician is 15 minutes away, and you need an appointment for flu shots. I can get to several pharmancies, grocery stores, and Costco in under 5 minutes.

 

[dawson5]

Hubby's work actually has someone come in to administer the shots. This open to all employees and their families. We have to pay $15, but we would have to pay $25 co-pay at the doctor's office anyways.

 

[daughtersrus]

Flu shots with our insurance plan are covered 100%. No copay, etc. The caveat is that they must be given in a participating physicians' office. Most physicians take our plan. It is SO much easier however to stop in at the many pharmacies, Costco, etc that are offering them and get one, however, they will not reimburse. Seems like it is far more convenient for the consumer and less costly for the insurance company, that they would want to do it that way, but nope.

Having a DD with a rare genetic disease, I gave up trying to figure out insurance.

For example, our DD needed to have some parts on her wheelchair replaced. The medical supply company sent a quote to the insurance. They denied all of it because the plan doesn't cover repairs. They did say that since the chair was over 3 years old, they would cover a new chair. I explained to them that since DD doesn't grow very fast, there's still plenty of growth left in the chair and we just needed new tires, anti-tip bars and a few other pieces. The total was a few hundred dollars.

The answer I got from the manager of benefits at the union was "We don't pay what's cost effective. We pay what the plan covers". So instead of paying a few hundred dollars, they paid over $8,000 for a new chair. We had already met our yearly out of pocket so there was no cost to us.

Another example is that they don't cover any immunizations after 2 years old. We got letters of medical necessity from my DD's doctors explaining that the disease has weakened her immune system and that she needs to get a flu shot yearly as well as the Prevnar, Pneumo Vax... They denied it saying that if she got sick they will cover the bills but that they will not cover the shots to prevent them.


I could go on and on but these are just two examples.

I should add that the insurance is self-funded and there are always articles in the union newsletter about how members could help keep costs down.

 

[golfgal]

Having a DD with a rare genetic disease, I gave up trying to figure out insurance.

For example, our DD needed to have some parts on her wheelchair replaced. The medical supply company sent a quote to the insurance. They denied all of it because the plan doesn't cover repairs. They did say that since the chair was over 3 years old, they would cover a new chair. I explained to them that since DD doesn't grow very fast, there's still plenty of growth left in the chair and we just needed new tires, anti-tip bars and a few other pieces. The total was a few hundred dollars.

The answer I got from the manager of benefits at the union was "We don't pay what's cost effective. We pay what the plan covers". So instead of paying a few hundred dollars, they paid over $8,000 for a new chair. We had already met our yearly out of pocket so there was no cost to us.

Another example is that they don't cover any immunizations after 2 years old. We got letters of medical necessity from my DD's doctors explaining that the disease has weakened her immune system and that she needs to get a flu shot yearly as well as the Prevnar, Pneumo Vax... They denied it saying that if she got sick they will cover the bills but that they will not cover the shots to prevent them.


I could go on and on but these are just two examples.

I should add that the insurance is self-funded and there are always articles in the union newsletter about how members could help keep costs down.

Then you need to address this with the union because they are the ones that picked the coverages-the insurance company is just administering the plan per their contract. They don't have any say in what is actually covered.

 

[DebbieB]

Hubby's work actually has someone come in to administer the shots. This open to all employees and their families. We have to pay $15, but we would have to pay $25 co-pay at the doctor's office anyways.

My insurance does not charge the copay for a shot. It's not considered an office visit.

 

[DawnCt1]

Hubby's work actually has someone come in to administer the shots. This open to all employees and their families. We have to pay $15, but we would have to pay $25 co-pay at the doctor's office anyways.

DH's company provides flu shots for all employees and family members for free. It isn't convenient to go there however. We also have no copay for flu shots.

 

[barkley]

you want convenience? there's going to be a drive through flu shot clinic sponsored by our public health department. kids are free, adults are $10. people with medicare and medicaid can get a form to fill out ahead of time for insurance billing. you can have up to 3 passengers in addition to the driver.

they will also be doing walk in's at the same location if people don't want to have their shot given to the in their car.

 

[DawnCt1]

you want convenience? there's going to be a drive through flu shot clinic sponsored by our public health department. kids are free, adults are $10. people with medicare and medicaid can get a form to fill out ahead of time for insurance billing. you can have up to 3 passengers in addition to the driver.

they will also be doing walk in's at the same location if people don't want to have their shot given to the in their car.

Long drive however! The car would be fine, except I like it in my right arm.

 

[DVC-Don]

Our family doctor stopped offering the shots several years ago and refers us to the local pharmacies.

 

[bookgirl]

My employer self insures, so on our big Staff Development day, they just have a bunch of nurses come to the venue and we all file through and get our flu shot (it's always held on Columbus day so perfect timing). I guess it's cheaper for them to just pay the nurses and buy a bunch of vaccine then to pay for us all to go to our doctors. However I've been in the Dr's office a lot lately and they always are "did you want to get your flu shot?" "don't forget to schedule your flu shot.". It probably would have been easier to get it at the office this year.

 

[diznygirl]

Clearly it does involve contracts, but if I were writing contracts, I would find a way to limit costs and let patients access the most convenient and AFFORDABLE means to a vaccination. I take DS to the local pharmacy when he comes home from college Thanksgiving break.

But the contract is written to protect the doctors - taking patients away from doctors takes $$ away from them.

Poor doctors, not making enough money.

 

[tlbwriter]

But the contract is written to protect the doctors - taking patients away from doctors takes $$ away from them.

Poor doctors, not making enough money.

I doubt they are reimbursed very much for giving flu shots - it would be more profitable to spend that time on actual sick patients. And of course the doctors don't give the shots anyway.

 

[DawnCt1]

But the contract is written to protect the doctors - taking patients away from doctors takes $$ away from them.

Poor doctors, not making enough money.

So you don't think that physicians should make money for the work that they do? Insurance companies are also in business to make a profit, although it is relatively modest when compared to other businesses and industries, in order to stay in business. I don't think most physicians mind if their patients get flu shots elsewhere due to the heavy patient loads that most of them have.

 

[daughtersrus]

Then you need to address this with the union because they are the ones that picked the coverages-the insurance company is just administering the plan per their contract. They don't have any say in what is actually covered.

I do address this these situations with the union. The union is a self-insured. The board of directors decide what is and what is not covered. When we need to file an appeal, we do so with the board of directors at the union office. When I have a question and call the number on our card, the call goes to the union office and is answered by them.

Self-insured plans are different from traditional plans. In our case, BC/BS is the administrator of the plan but they do not pay any claims, they only process them. The union then pays all of the claims directly. The check for the wheelchair did not come from BC/BS, it came from Local 701.

I was trying to save them over $7,000. It really didn't matter to me since we weren't paying any of it since we already met our $2,500 out of pocket expense for the year.

 

[scrapquitler]

Unfortunately, logic and common sense do not always prevail in the operations of health insurance companies.

Way back when, in the last 80s when insurance companies were not required to provide coverage for birth control pills under the prescription plan, I was on the pill, and my insurance company denied my claim to pay for my prescription. They didn't seem to understand my logical argument that it would be FAR less expensive to cover birth control pills for a healthy, sexually active young woman who WOULD statistically be likely to get pregnant than it would be to pay for the expenses of covering the resulting likely pregnancy. "Well, its not required that we cover it"