According to a handful of phone calls I’ve made this week to schedule a physical (required for a New Zealand work visa), receptionists and customer services reps have alluded to me that scheduling and receiving routine immunizations for travel is not covered by insurance. One even said only kids vaccines are covered under Obamacare, that I can pay $100 a shot, submit it to insurance and “fingers crossed” I would be reimbursed.
Which is bunk. Insurance plans are now required to cover 10 essential health benefits (see above), including a list of adult immunizations.
For Vietnam, the CDC says that all travelers should receive routine immunizations (MMR, Diphtheria-Tetanus-Pertussis, Chicken Pox [Varicella] if you didn’t get it [the illness or shot] as a kid, and a early flu shot); most travelers should get Hepatitis A and Typhoid; and some (depending on length of stay or other scenarios) should get Hepatitis B, Japanese Encephalitis, Malaria, Rabies and or Yellow Fever. MMR, Tetanus-Diphtheria-Pertussis, Hepatitis A, Hepatitus B, and Varicella are vaccines covered under Obamacare as preventative care. The others, you have to pay for, which makes sense to me.
On Wednesday, I had my insurance’s customer service rep concede that if a visit for an annual well-person checkup and shots is billed as a preventative care visit, routine immunizations like Hep A or B; MMR; or Tetanus-Diphtheria-Pertussis should be covered. But if the visit is billed for travel, the visit and shots will not be covered. (The automated responses before I was connected to a human also provided a disclaimer that any conversation should not be taken as a concrete explanation of benefits.)
Which begs the question: From a public health perspective, why does it matter why myself or someone else wants to keep their immunizations up to date? Some costs are covered if I stay put, but not covered if I move around? Wouldn’t it make more sense to immunize those that travel often?
I did find a doctor’s office with a receptionist who was extremely helpful. I explained to him that I need to schedule a well-person physical, I need some routine shots, and I want insurance to cover it as much as possible. (I pay for a PPO through my employment, so I hope it would cover as much as possible.) And also: I will need the doc to fill out a New Zealand physical exam form. The receptionist said I should be able to get this billed as preventative care, but I may need to come back for another visit [pay another co-pay] so the doctor can have time to examine and report the blood test results on the physical form.
I’m definitely no doctor or health policy expert. But I’ve edited a fair number of Obamacare articles at Governing magazine a couple of years ago. I know what the 10 essential health care benefits are. If I got something wrong or my logic isn’t checking out, please correct me by emailing me via the contact form with what I should know.
One positive thing we learned this week regarding immunizations: CVS pharmacies can administer them! The Kiwi got a needed jab pretty quickly. It was $60ish out of pocket. Good to know.