My flu shot experience

[NewJeffCT]

So, I had to pick my wife up the other day and I got there a bit early. I decided to finally go in to get my flu shot at the local CVS on the way.

I figured I would have to pay the normal $10 or $20 co-pay you have for a flu shot. However, when the CVS pharmacy technician tried to put in my insurance from Cigna, she told me that I was not covered at all. That seemed odd, but since I had filled out the paperwork already and needed to run to get my wife, I decided to give Cigna a call after I got my wife.

Afterwards, I called Cigna and they told me the insurance gives me 100% coverage for immunizations, so I would not need to pay a penny. However, CVS needed to process the flu shot claim through Medical benefits and not Pharmacy benefits. If CVS needed any help, they could just call Cigna, I was told, and Cigna could walk them through the process because they do that all the time.

So, I go back to CVS and told them what Cigna told me, and everybody at the pharmacy there seemed to be totally stumped – how can we process a claim through Medical, we’re a pharmacy? So, the pharmacy technician called Cigna at my insistence. They went back & forth several times and I was waiting there for close to an hour. However, CVS and Cigna could not resolve the situation and figure out how to process the medical claim.

It’s not like the $31.99 flu shot (uninsured cost) is going to force me into bankruptcy or anything, but I’m really frustrated now, and I now have to leave because my daughter needs to get picked up from school this day as well. But, I’m also to the point where I’m insisting I'm not going to pay a penny for this flu shot.

After that is done, I called Cigna back again and we had a three way conference call between myself, Cigna and the local CVS store where I keep getting frustrated. This was after explaining the situation and waiting on hold for another 15-20 minutes. They were still not able to resolve the situation when I had to eat dinner. So, the person at Cigna said they would call me back when the situation was resolved.

That was two days ago. I was too busy to call yesterday, but finally got around to calling Cigna this morning to see if the situation was resolved and ask them why I never got a call back. Cigna has records that I had called, but nothing outstanding in terms of an unresolved issue. I had the Cigna person repeat that, just to make sure I heard it correctly. She also had no record of me needing to be called back. However, they again insist that they process these flu shot claims from CVS through medical all the time, and seem surprised that CVS cannot do it.

So, I called my local CVS again, and they seem to be totally confused by the situation. They insist that they could not have even called insurance until after I got the flu shot, but I told them that wasn’t how it worked the other day when I was in there. However, they can’t seem to enter my insurance information into the system now, either, and don't seem to understand why Medical and not Pharmacy.

I’ve probably spent a good three hours and three trips to CVS just trying to get a friggin’ flu shot resolved. Gotta love our healthcare system.

I guess I’ll go to Walgreens or Rite-Aid now instead.

[onehandle]

1. Our insurance mailed us letters which we handed to Walgreens and didn't pay a penny.

I actually prefer CVS, but we are required to go to Walgreens for prescriptions, etc.

[hedgehog]

2. I think right now, most pharmacists and doctors secretly long for the day

Single payer is the law of the land!

[RKP5637]

4. Yeah, same here. This botched up band-aided together mess we have today is

stupid and needlessly complex, and so damn backward.

[raging_moderate]

11. That's no secret.....

I would say that around 90% of the other physicians/NPs/PAs I work with agree with me that were pretty much doomed unless we can get universal health care figured out somehow. Admittedly those I work with are in a rural area, and predominately in primary care. There are also a lot of fears about how some of the attempts to regulate what we do to date seem overly onerous and at times seem to add more to the problems as opposed to helping the situation. Overall, our healthcare "sytem" is an absolute disaster.

[CTyankee]

44. eggzackly! It's a mercy that I'm on Medicare (single payer). I went to the Stop and Shop

pharmacy counter and requested a flu shot, sat down and got it forthwith. "No charge."

Over and done with in about 10 minutes...

[Brickbat]

3. Don't you see how much better it is to have insurance companies and corporations get between you and

your doctor than the government? It's like you hate the free market, or something.

What's frustrating is imagining the people who DON'T have the decent health care, the educated self-confidence to push through bureaucracy, the time to play these reindeer games, or the support from spouses and friends to drop everything to deal with this shit. The system itself is sick and broken.

[RKP5637]

6. "The system itself is sick and broken." And even that is a complement to this F'ed up system. n/t

[csziggy]

5. I HATE CIGNA with a passion!

Their system is designed to make it hard to get benefits so they pay as little as possible.

I ended up paying over $300 for my shingles vaccination because my doctor's group is "not in network" and I also paid the full price for my wellness exam including my bloodwork, mammogram, and bone scan for the same reason - even though under the ACA, wellness exams are supposed to be fully covered. According to CIGNA, that only counts if I got to one of their in-network doctors.

I've been using this doctor for years before the company my husband works for switched to CIGNA. No other insurance company was such a PITA about continuing with our selected physicians.

Same with the orthopedic group I have had working on my body since 1993 - they are not in-network, so I have to pay significantly more. This is one of the best orthopedic groups in the SE. I am not going to switch to one of the orthopedic doctors CIGNA does accept in-network - they have worse records and are not as well respected. CIGNA tried to get me to do that before my knee replacements but the surgeon they recommended had a very bad record - not someone I want messing around with my joints!

FUCK CIGNA!

[hedgehog]

7. Here's the irony - presumably the patients of the surgeons with worse records

end up needing more care. So how much is Cigna saving by not going for the top tier?

[csziggy]

17. I know - it doesn't make sense

I do have to say CIGNA did allow me (with assistance from the patient advocate at the facility) to spend more than a week with each knee replacement i a rehab facility. Originally with each they wanted to send me home and they planned to send a physical therapist to my home twice a week.

The patient advocate was great - he argued that I had several justifications for getting into the rehab hospital. It certainly made a huge difference in how quickly I was walking well and completely independent. The rehab place required three hours a day of therapy. At home on my own, I would not have been as rigorous. My knees healed wonderfully and the worse pain I have any more stiffness if I stay still too long.

Once CIGNA capitulated, there were no problems with payment for the rehab. Other stuff, not so great.

[sharp_stick]

8. My wife and daughter

had is done for free, no line, no identification, back in November at one of the firehalls in Middletown.

They had several free flu clinics in my area (Middletown, Durham, Cromwell) between October and the end of November but I'm not sure if they are still going on.

On edit: it looks like it was finished here in December. This is the notice

http://middletown-ct.patch.com/articles/free-flu-shots-begin-tuesday

[Lex]

9. CVS processed thru my Blue Cross ins. when I got my flu shot and I

had no problems whatsoever, so I'm sorry you had to deal with that insane crap. I was in and out of CVS within 30 minutes, no need to pay as my ins. covered it. They didn't even bat an eye about how to process it--never even mentioned it to me.

[enough]

10. Really strange. Around here all the pharmacies (including CVS) have signs out

advertizing free flu shots. The signs have been around for months.

[WinkyDink]

12. I just go to my GP.

[NewJeffCT]

18. I normally do as well

but, the job I've had the past year has made going to my GP less convenient, and I was hoping that my company would either have a flu shot clinic (they didn't), or that I'd be able to go to one of the five pharmacies within 2 miles of my workplace to get one.

[The Velveteen Ocelot]

13. Walgreen's has a pretty good system.

I went there for my flu shot. Handed them my insurance card (United Health/Medica); they ran it through their computer and within a couple of minutes they came back and told me there was no co-pay, so no charge. After another 10 minutes (at most) to fill out the paperwork and actually get the shot, I was on my way. Sounds like somebody at CVS had no idea how to process these things.

[NewJeffCT]

15. I went to a Walgreens near my work first

but, they were out of flu shots, and my lunch hour had run out by the time I got to the CVS near my work.

[CreekDog]

14. this shows the advantage of single payer --it took 3+ hours of staff time to give you a $32 flu shot

no wonder our healthcare costs so much, there are a ton of people whose job it is to save money by spending hours discussing what's covered and not covered.

and none of this provides health care.

[NewJeffCT]

16. Between the pharmacist, her assistant

and the customer service people at Cigna, I'm guessing they've probably spent 10x the $32 going round & round on this flu shot.

Not to mention the frustration of all the people waiting in line behind me at CVS that time the pharm tech was on the phone going round & round with Cigna.

[abelenkpe]

19. Had similar situation with Cigna and my eye doctor

I go to my regular doctor and she gives me a referral for an eye exam and the doctor I need to see. I make the appointment with the eye doctor and give them my insurance information. I'm double covered by my husbands plan and my work's plan. His plan provides 10,000 a year for vision and dental. So does mine...at least according to our workplace. Two weeks later I take a day off work and go in to the appointment. I sit and wait an hour until my turn comes up. When I'm about to go in the receptionist tells me my appt will cost 80 dollars for an eye exam because cigna medical will only cover a glaucoma test. I tell her I have the vision plan too and already gave her that information. She then tells me they only accept medical. Why didn't she tell me that when I made the appointment? So I left. Called Cigna and they swear there is no reason for her not to accept the vision plan. I go back to my doctor and she gives me a new referral to the exact same doctor insisting that the eye doctor can use my insurance. So yeah, we've been around and around with this three times now over two years and I've still not had an eye exam.

Hope you can get your flu shot today. Good luck!

[laundry_queen]

20. My Canadian flu shot experience.

I went to the pharmacy. I asked for a flu shot. I filled out a consent form that had my name and health care #. I got my nose spray immunization. I hung around for 15 min (standard, in case of reactions) and then went home. I didn't pay a penny. The end.

I feel for you - I really do. Your system just plain sucks.

[u4ic]

32. But...did you get your 100 Air Miles as well?

[laundry_queen]

35. LOL...no

No convenient Safeway for me

[slackmaster]

21. I got mine at a Vons supermarket pharmacy. In and out in under 10 minutes.

My insurance is with Aetna, and of course it was 100% covered.

[pansypoo53219]

22. BUTBUTBUT amerika has the BEST medical system!!! whoops, i meant expensive.

[Motown_Johnny]

23. Walgreens charged me the 31.99 saying I wasn't covered

Last edited Sat Jan 19, 2013, 09:22 PM - Edit history (1)

and since I had other things to do I just paid it and moved on.


I guess I could spend three days trying to see if I can get reimbursed for the shot, but it seems like a lot of trouble.

I will admit, you have piqued my curiosity.

[NewJeffCT]

27. Normally, I would do that as well

but, after getting the runaround with this, I'm determined that it will be free.

[Motown_Johnny]

29. I wish you luck

but you know it takes about 2 weeks for your body to develop the immunities after you get the shot. So don't wait to long.

[shift happens....]

45. Or PIQUED it?

In any case, consider yourself LUCKY if you didn't get it!!!!

[Motown_Johnny]

47. You are correct and I edited my post

To bad your posting privileges have already been revoked. As a rule I like people who use the English language properly.

Good luck to you.

[0zone]

24. Happens everytime

Every visit to the doctors becomes an unnecessary hassle. They do this stuff day in and day out 8 hours a day 365 days a years and yet none of them know what they are doing.

[s-cubed]

25. Gee, got my at Safeway, no copayment, and got a $10 coupon for groceries. Yah Medicare! nt

[NewJeffCT]

28. I was supposed to get a coupon for 20% off at CVS

if I got my flu shot there as well.

[Rider3]

26. Our "fine" healthcare system at work.

We should take a page from Norway's healthcare. America's is a joke, and I laugh at anyone who says, "We have the best healthcare in the world." Bullshit.

[CTyankee]

46. I really don't think anyone believes that any more. I think the RW here is so afraid of Obama's

ACA because they know that the more health care people can get, the more they like it and prefer it to our old system. Just look at how popular Medicare is.

I really wish we could bring back the old "Medicare for Everybody" idea. It would be a winner!

[JDPriestly]

30. Your insurance company should have issued you a pharmacy card as well as a medical card --

proof of insurance. That would have settled it right there. CVS and your insurer could have fought over the bill without delaying your flu shot.

Or better yet, we could have a single-payer insurance coverage managed by government agencies. Everybody knows from the get-go that everyone is covered for specific services and procedures, and the government simply ferrets out fraud. That way the insurer/government would not have to go through all the questioning about whether your specific plan covers this that or the other.

The private, for-profit insurance company system delays healthcare, and sometimes that costs not just money but lives. You realize that by the time you had talked you CVS, your insurer and back and forth, you had cost everyone involved in terms of employee wages, phone charges, paperwork, etc. a lot more than $31.99 or whatever the flu shot costs.

False economy. We are paying quite a bit more for our medical care simply because we have private, for-profit companies involved in delivering it.

[NewJeffCT]

34. well, the problem is that it's not covered through the pharmacy benefits

Cigna specified it's covered under medical benefits.

[NV Whino]

31. I took a survey from Blue Cross this morning

Twice I had the opportunity to make a (one sentence, they insisted) comment about how they could improve. Both times I wrote, single payer, national health care.

As for the flu shot, I volunteer at a local hospital once a week. They simply come around once a year and poke the volunteers if they want, no questions, no insurance needed.

Yeah, let me say it again. Single payer, national health care.

[GP6971]

33. Same thing at Safeway

I also have Cigna and Safeway advised that insurance didn't cover the shot. I'm calling Cigna to see if I can submit a cliam for reimbursement.

[bvar22]

36. Good thing that they won't be able to give us the Run Around...

...once The Mandate kicks in (2014).
.
.
.
.
Oh Wait.
Yes they will.
probably worse, as THEY will be In Charge,
and if you get so frustrated you try to FIRE them,
you get reported to the IRS.

2104 WILL be an interesting year.





You will know them by their WORKS,
not by their rhetoric, promises, or excuses.
[font size=5 color=green]Solidarity99![/font][font size=2 color=green]
--------------------------------------------------------------------------------------------------------------------------------[/center]

[hedgehog]

37. My GP is giving up on administering a lot of vaccines -

he has to pay for the medication up front, then hope it gets used before it goes out of date. He doesn't stock meningitis, Hepatitis or shingles.

I hate to admit it, but I'm not sure my daughter ever completed her series for hepatitis - getting her down to the County medical center fell into the cracks.

I'm not certain she ever had her meningitis shot.

I had to go to a pharmacy for my shingles vaccine. Unless I keep the records, no one will document that!

[WolverineDG]

38. Wow

Didn't have this problem at Walgreens. Just handed them my insurance card & here's your shot, free of charge.

Sounds like the problem was with this particular CVS pharmacy, though.

[NiteOwll]

39. We had a problem getting flu shots at Target a few days ago.

After they ran our (medical) insurance, they told us that it doesn't cover flu shots at that type of "venue" -- apparently meaning a pharmacy. We have Blue Cross so I'm a bit surprised they won't cover flu shots but I haven't checked on it yet.

[hedgehog]

41. Check to see if you're covered under your pharmacy plan -

my Blue Cross didn't cover the out-of-network provider, but the pharmacy plan covered the vaccine and the druggist gave me the injection. At $212 per dose, the pharmacy chain doesn't mind throwing in the actual injection for free!

[hack89]

40. Paid nothing at a state of RI flu clinic. nt

[Vinca]

42. I'd send a copy of your paid bill and insurance card to CIGNA and demand reimbursement.

Politely, of course. You might explain the whole problem again. Before closing, though, be sure to add you will be contacting the state insurance commissioner if you can't resolve the problem. I went around and around and around with coverage in the "Obamacare" pre-existing condition pool over a routine colonoscopy which I was assured was a covered procedure before having it. They paid the doctor immediately, but the hospital bill of nearly $1,900 was rejected for some mysterious coding reason the hospital didn't comprehend. It was a frustrating song and dance and after 6 months I finally gave up and paid the hospital. I then wrote the plan again and told them they had one chance to make it right before I contacted the insurance commissioner. Bingo! Got their attention. They paid the hospital and the hospital reimbursed me.

[shift happens....]

43. Price you pay for being a sheeple!

Try buying some orange juice, squeezing it yourself and drink! Knocks out the flu just. like. that.