Monday, September 12, 2011

Travel Shots Uncovered

Written by Karen
Florence, Oregon
I got my first round of travel shots last Friday.  I received the basic travel shots for the tropics and getting off the beaten track: Hepatitis A, Hepatitis B and Typhoid.  I was already up-to-date with my DTaP: Diphtheria, Tetanus and Pertussis (Whooping Cough), so I thought I’d tack on the additional travel shots to my regularly scheduled doctor’s visit.  
You would think this would be a relatively straightforward process, however, it turned out to be much more complicated, unnecessarily so in my humble opinion, then just walking into the doctor’s office and getting pricked. And, just to add another layer of potential complication, I wasn’t sure if our medical insurance would cover these travel shots. Since it is rarely clear in the insurance world as to what is covered and what is not covered, I figured I would just take things as they came.  

If I had to hedge my bets, I was figuring that our medical insurance would not cover these travel shots.  In the travel blogs that I have read, the consensus seemed to be that most insurance plans did not pick up the costs of the travel shots.  Adam had already received his Hepatitis series travel shots, also from Stanford, and we had received notice from our medical insurance carrier that his shots were under review.  So, it seemed like it was trending toward us paying for our travel shots, and that was ok. 
Florence, Oregon
Although, just as an aside, it seems that it should be a public health priority to ensure that US citizens don’t come down with these easily avoidable diseases; a penny of prevention equals a pound of cure.  How much is it worth to not get hepatitis or typhoid?  
Anyway, after my doctor’s visit, I was chatting with the receptionist as she was filling out the paperwork for me to get the travel shots.  She handed over a document for me to sign regarding accepting personal responsibility to pay for the travel shots.  That raised a couple of red flags for me.  I asked about whether she could check if my insurance would cover these travel shots, and if not, what were the costs that I could expect to pay?  
Surprisingly, Stanford could not locate a price list nor could they confirm whether my insurance would cover the travel shots.  This stopped me in my tracks in complete bewilderment.  How can this be?  One of the largest medical institutions - and one that usually has their act together - wants me to sign the equivalent of a blank check?
I let the receptionist know that I would need to cancel my travel shots and would re-schedule at another time.  I figured I’d call my insurance carrier and try to get some additional information before I committed to getting the shots.  But then, I received some very interesting information.
The receptionist leaned towards me, and after a quick glance backwards over her shoulder, said very quietly, ‘you know, there are some pharmacies around here that provide travel shot services that you might want to look into.  They won’t charge you any administrative fees like we do here at Stanford.’
Wow.  I thanked her and left to go investigate this new and rather stunning information.  
It turns out there are such things as specialty pharmacies who offer a variety of services, including providing travel shots. The specialty pharmacy that I went to was Walgreens in downtown Palo Alto.  At this particular pharmacy, all of their pharmacists are certified, so there is no need to schedule an appointment.  You can just drop in.  The prices were clearly listed and they were quickly able to look up my medical insurance and let me know if I was covered.  There are no administrative or other hidden fees associated with providing the travel shots. 
London, England
Surprisingly, it turned out that I was covered by my medical insurance for the Hepatitis A and Hepatitis B shots, but I wasn’t covered for the Typhoid shot.  
And, then I received some more surprising information.  If you have an AAA automobile card, you can submit your card to the pharmacist for a discount on those travel shots (and medications) that are not covered by your medical insurance.  Who knew?  The discount ranges from 10% to 90%.  So, that’s what I did.  The Typhoid shot was originally $94.99, but with the AAA discount the cost for the Typhoid shot dropped to $59.52.
I went ahead and had all three shots right then and there.  I’ll need a follow up Hepatitis A booster shot in six months, but otherwise, I’m inoculated.  My total out-of-pocket cost for the basic three travel shots was $59.52.
I’ve provided some additional information that I have received from Stanford and Walgreens regarding the charged or retail costs for the three travel shots that I received:
Walgreens - Retail costs: Hepatitis A (does not include booster): $79.99;  Hepatitis B: $99.00; and, Typhoid: $94.99;  Total for all three travel shots: $274.97.
Stanford - Billed costs: Hepatitis A (does not include booster): $99.99; Administrative fee: $85; Hepatitis B: $179.00; and, Administrative fee: $85.   Total for two travel shots: $448.99.
The differences in the costs between the two options are fairly significant. 
Florence, Oregon
So, here’s an idea to consider for the health care and health insurance reform debate.  Let’s have transparent, openly posted and consistent fees for products like vaccinations.  Stanford is charging more than double for the same exact products.  Will my insurance pay for those extra fees?  I don’t know.  But, why should they?  If I had signed that Stanford document taking personal responsibility for the travel shots, would I have been on the hook for the additional costs and administrative fees?  And, for those individuals who don’t have insurance and don’t know about the option of specialty pharmacies, why should they have to pay so much more at a doctor’s office than if they went down the street and got the very same series of shots that I just received at half the cost?  I realize these are just two very small examples in the much bigger picture of public health, but I think it begs the question to look a little closer.  
It seems that it should be a public health priority to establish consistent costs for similar medical items; a readily available and transparent price list of medical items that are in the public interest, like vaccinations.  Not only should these price lists be readily available, but alternatives should also be clearly noted, and not just in the fine print or through happenstance. It should not be left up to serendipitous chance to find out about alternatives, such as specialty pharmacies and the significant cost savings that are possible by choosing that option.  
"Life is a great big canvas, and you should throw all the paint on it you can."  Danny Kaye


moneyIQGuy said...

My head starts to get a feeling of tightness, a premonition of a forthcoming headache, just imagining being in that kind of bureaucratic situation. I'm glad that someone showed some human kindness, and that you were able to navigate the system. When these kinds of things are *so* hard to navigate, it just creates unnecessary hurdles between people and their maximizing their health

Observers of Life said...

Hi IQ -

I agree - things really don't have to be so complicated. And, now that we know about these speciality pharmacies and the AAA discounts, we have to pass that little tidbit of information along.