HillRiderEast

let me set everyone straight. The accountable care act (obamacare) mandates insurance to cover any test or procedure recommended by the US Preventive Task Force that carries an A or B rating. This nifty list from one of the BCBS plans provides a list of the things insurance is mandated to cover without any patient copay or out of pocket expense. Because of politics, the law does include a grandfather clause exempting certain employer groups from having to cover these things, but with the provision, that once they change any little thing in their health plan, all these things kick in and no more grandfathering. These companies would be the large employers that self insure, but over the years since the passage of the law, there are fewer employers who are grandfathered.
A simple call to your insurance plan to make sure the immunization covered will resolve the issue. Get the shot and save yourself some grief. Look at the rest of the things you are also qualified to get without having to pay a copay or anything else. Screening Colonoscopy is one of the most important,
https://www.bcbsnc.com/assets/campaig...rvices_grp.pdf

JohnDThompson 

No, in the United States, it means the insurance company only wants to pay once.

August West

Thanks HillRiderEast. I checked with my insurance and they confirmed the vaccine would be covered. Blew me away. I just have to go to the pharmacy, give them my insurance card and they should take care of the rest. I never dreamed this would have been covered since my company provided insurance/HSA is pretty terrible and without prescription coverage so I didn't think it was even think about seeing if a vaccination would be covered. Especially for what is considered a nuisance disease and not life threatening. Now, I'm sure I can find some cycling gear to spend that $206 on instead

Ali_Pine

It didn't hurt a bit.

If you have insurance, it's likely covered. My cost $15. Don't know/care what the insurance company paid.

Get it with a Flu and Pneumonia shot. You will be back in the saddle in no time.

JohnJ80

For almost anyone, while the upfront cost seems steep, if you get shingles, you'd be willing to pay a lot more. Unless, of course, feeling like you've been doused in gasoline and lit on fire is tolerable for you. It's that pesky marginal cost value proposition thing all over again.

You should care. What the insurance company ultimately pays is what is driving all our premiums upwards. Give you an example: When I got shingles, my doc prescribed a common anti-viral drug to help mitigate the symptoms. He's a personal friend of mine, so he spun the monitor around for me to look at. The choice was both the same drug but one was to be taken 3 times a day and the other was to be taken 5 times a day (less convenient). The cost for the first one was $40. The cost for the second was about $140. The only difference was taking it twice more per day. My co-pay in both cases was $20. In the insurance industry this scenario is replicated millions of times. The stupidity of our co-pay custom is evident. More cost savings would be driven if the co-pay had some tracking with the actual price of the medication or certainly in cases where there are equivalent alternatives. The disconnect between cost and treatment/medication removes all the economics from the choice by the patient.

J.

nobodyhere

This is the 10th anniversary of my wife (now 78 yo) getting Post Herpetic Neuralgia as a result of Shingles. For 10 years now she has had extreme pain every single afternoon and evening. We have spent thousands above what the insurance (medicare plus our supplement) has paid in pretty much failed efforts to find solutions. She now takes opiates and other medications to make it through each afternoon. Shingles has caused permanent damage to her nervous system, and in the process, it rewires the brain's pain responses.

There were no shingles shots 10 years ago. If there had been, we would have gladly paid whatever amount they charged for a shot to either prevent or reduce the severity of the symptoms.

Make you own choice, but keep in mind that the results of shingles can be far more serious than they show on the TV ads.

Not looking for suggestions here. We have tried everything.

Just sharing our experiences.

August West

This sounds exactly like what my mother went through before she passed away. Agony every day the last few years of her life. You and your wife have my sympathy knowing how Post Herpetic Neuralgia can pretty much destroy any chance of normal life for its victims. I probably wouldn't have bothered with the vaccine before but after seeing what she went through I would pay pretty much anything amount for it (but fortunately it is covered for me).

HillRiderEast

Hardly anyone will have any out of pocket expense for this immunization because of the accountable care act. just make the call to your insurance and verify

Grand Bois

I can confirm that. I also had to ask. My mother had shingles and suffered terribly. She was about 75 at the time. I got the shot at her insistence. I'm glad I did.

Country23141

My insurance covered it 100% even though I have crappy and expensive insurance. Took it when I was 50.

CbadRider

I got it last year and it was given as a subdermal injection instead of intramuscular. I had a lump under my skin for about 3 weeks and occasionally it would itch. Nothing besides that.

jgadamski

My insurance covered it all.. and I don't have great insurance. the key for the insurance co was that i was over 60. Had I got my vaccine at 59.99 years it would have been expensive. Once you reach 60, it is much better. Check with your insurance co and find out coverage. And how you can reduce costs. But I feel much better having had it. I have watched others suffer . and suffer they did.

huffman 

The recommended age for the shingles shot very recently moved from 60 down to 50. My wife's office arranged for Rite Aid to come into their office and give everyone their flu shot, anyone 50 or over could get their shingles shot too. I got the flu, shingles & Tdap (tetanus/diphtheria/pertusis-whoopinc cough) shots at the same time with nothing out of pocket. I mountain biked that afternoon with no problems and a week later have had no issues. My job takes me into the local hospital and numerous medical clinics every week so I can't be too careful. A high school friend of my wife got shingles in her early 50's and it's just about ruined her life. Years later she is still suffering from the effects.

August West

Well, I went by the pharmacy today to get my shingles vaccine and guess what, they were unable to provide the shot since it had to be billed to the my health plan, not my prescription drug plan (which is more of a joke than a plan). This after I spent over 1/2 hour online with Anthem BCBS last weekend and was assured by their representative that I could could go to the local pharmacy (Safeway or Costco) and get the vaccine.

The pharmacist said since they, as a pharmacy, can only bill prescription drug plans and not health plans they could not provide the shot unless I paid for it in full. He also said it not unusual for insurance companies to provide incorrect correct information on the phone or online. He said he sees it every day. His recommendation was going to a CVC or Walgreens mini-clinic which are staffed by nurse practitioners since they can bill health plans.

So I found a Walgreens mini-clinic and was able to get the Shingles Vaccine and as long as I was there I had them give me a Flu Shot and DTAP since I was long overdue for a tetanus shot. They were able to submit the claim to Anthen and it was pretty quick and easy. Also much cheaper than having pay for an office call to the doctor (since my plan doesn't have any co-pay an office call is full price). Now it will be interesting to see if Anthem actually pays for these vaccines. My guess is I will end up paying the full $320 out of my pocket after Anthem denies the claim but it will be worth it if it works in preventing shingles.

Rubble

As I think I said in the original post, I'd have paid $5000 for the vaccine if I knew then what I know know. I'm 3.5 months in and still taking Gabapentin for nerve pain. A couple times a week, usually at 3 am, I'm reaching for hydrocodone for pain that's just getting the better of me. Plus I now have hand tremors which make me scribble my name as if I'm a doctor. I'm refusing to let it run my life, fighting it all the way but, damn, it's relentless. Oddly, I don't feel it at all when I ride or go on a long fast walk. Must be something in those exercise endorphins that stunt the shingles pain. Wonder if I can get my insurance company to pay for my bike as therapy.

I wouldnt let $200 and insurance companies stand between me and that vaccine. I made that mistake.

DW_Thomas

My GP wrote me a prescription which was then filled as an Rx at my local CVS. My Rx plan is thanks to my spouse who used to work for the vaccine maker, so our plan has zero copay on that drug. Can't beat that. Like others upthread, I have a couple of friends whose experience I'd prefer to avoid -- even if it cost me $$$. One guy had an itchy spot that he describes as minor, but every now and again gives him a jab of pain like he's been shot!

fthomas

Had a case of shingles in the Philippines last year. To quote Robin Williams in " Good Morning Vietnam" the Philippines can be "crotch pot cooking hot!". Add the Shingles and the heat and it is extremely painful! My wife the Dentist ushered me over to an OBGYN Doc and I got prompt treatment that amazingly got it under control and I avoided the stirrups! Pain relief in PH is pretty poor - take two paracetamol - Tylenol. Trust me it wasn't very effective for shingles pain. A vicodin would have been truly welcome!

Get the vaccine! I pray I can avoid a repeat for sure