Shingles vaccine

[Sue J]

I was going to put this in the topic about getting jacked around by your insurance company but I thought I'd post this here.

Our insurance booklet (from Jan, 2011)includes the shingles vaccine in their "routine preventative" list with other vaccines (flu, pneumonia) that are covered at 100% with no deductible. I called in August to check about it and was told that there is no minimum age, the only requirement is that you get it through your doctor's office, not a pharmacy. Next time that I was at the doctors I asked about the shingles vaccine. I had the shot in Nov.

The claim was denied! I called when I saw the claim online and was told that in September the age restriction was changed to age 60, RETROACTIVE TO JAN 1, 2011!!

The person I spoke with about the denial was the same one that I talked to in August, my call was in their notes. She said that she would send the claim to her supervisor for review.

WTF! How can they change the age requirement retroactively? Are they going to go back and try to recoup from claims they already paid?

If I would have known, I easily could have waited until I was 60 for this. I thought I did the correct thing in calling about this ahead of time so that all went smoothly. But no, I'm dealing with a medical insurance company and they can do whatever they want. Right now it shows that I will owe $205, so that gives me plenty of incentive to follow through on getting this paid.

 

[East Texas]

Age 60 was the "old" requirement. The age was lowered to 50 sometime in late March or early April. I don't know what insurance you have; however, my Humana did not have an age requirement. Spouse has Aetna and they lowered the age to 50.

 

[Texas Proud]

Age 60 was the "old" requirement. The age was lowered to 50 sometime in late March or early April. I don't know what insurance you have; however, my Humana did not have an age requirement. Spouse has Aetna and they lowered the age to 50.

And I have Humana and they did not cover it no matter what age....


There are many plans under any company.... not every plan covers the same things....

 

[Lakedog]

I think many health insurance cos use CDC guidelines (still age 60), but some use the FDA approval (lowered to age 50). I know my federal health plan still uses age 60 - I called to ask if they would soon lower the age to 50, their reply was "only if the CDC changes their guideline".

My doc will give it to me prior to age 60, price is $200 out of pocket. Although you can get shingles at any age, he said most cases he sees (by far) are people above 60. He is around my age (55) so I asked if he had gotten the vaccine -- said he would likely wait until around age 60. I still haven't decided but may go ahead with it, was hoping CDC would change their guideline sooner rather than later.

 

[Dreamer]

My federal health plan, BC/BS, told me they would cover if 50 or older. I called them within the last month. I have my prescription and was waiting for my DH to get his and then go together. I guess that I will call ins co the day I go and make sure that I get the same answer and document who gave me the information.

 

[Lakedog]

My federal health plan, BC/BS, told me they would cover if 50 or older. I called them within the last month. I have my prescription and was waiting for my DH to get his and then go together. I guess that I will call ins co the day I go and make sure that I get the same answer and document who gave me the information.

Thanks for the info, I called mine (GEHA) about a month ago so I may try calling again after the first of the year, but it sounded as if they would not change until CDC made the recommendation.

 

[misanman]

Here's a good CDC paper on shingles and vaccination. Mentions that they are looking at whether a "booster" would be needed as effectiveness declines.

www.cdc.gov/vaccines/vpd-vac/shingles/.../shingles-vac-msg-2008.pdf

It's dated 2008 so maybe there's something more recent.

 

[Dreamer]

DH and I both received our shingles vaccines today. Neither are 60 yet and my Fed health insurance covered it. Thanks to everyone for keeping this thread going, because I probably would not have thought about getting them before reading this thread. A friend just sent an email that her DH was in extreme pain and they found out he had shingles. He had just had knee surgery, so they were surprised that pain was from the shingles.