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By Ian Wasser

Recently, I went to the doctor for my annual checkup.

It was time for me to update my immunization against tetanus and diptheria.  A standard immunization, and one that would seemingly be covered by health insurance.

I don’t have the student health insurance plan.  Instead, I am insured through my wife’s employer.  We have a good health plan–a nice, high deductible PPO plan that covers almost everything.  Not gold-plated like a Congressional plan, but certainly not the bare minimum of coverage.

Much to my surprise, I learned that routine immunizations for people over 18 are not covered.  The only exception is yearly influenza vaccination.  I checked my policy–sure enough, immunizations were listed as an exclusion.

The interesting part is that while immunizations are excluded, the administration of injectable medicines are covered.  The doctor’s office billed the immunization as two charges–one for the medicine and one for the administration of the drug.  Both charges were rejected by my insurance on the basis of being excluded.

My question is this:  I agree that the cost of immunization is not covered.  That is clear from the policy language.  The immunization was injected, however, and injections of medications are not excluded from the policy.  Is it worth a fight to get the insurance company to cover the cost of receiving the injection?

And, more importantly, shouldn’t all health plans include coverage for routine immunizations?  Why don’t states mandate such coverage?  After all, people only need these immunizations on an infrequent basis.  And failure to take the precaution of getting immunized creates a much greater risk for the insurance company–should I become infected with tetanus, the cost of treatment would certainly exceed the cost of immunization.

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One Comment

  1. This post raises the issue as to the point of health insurance. If the point of health insurance is to transfer “risk” of unusual medical events, then I am not seeing why insurance should cover routine and predictable immunizations. We don’t have insurance to pay for purchase of needed shoes. On the other hand, we want insurance to cover non-routine vaccinations like a rabies vaccine. Tetanus immunizations might be in a gray area. We should get them periodically and predictably. They aren’t hugely expensive. So maybe they are not the sort of thing insurance should cover. On the other hand, if you haven’t had one recently — or don’t remember if you did — then they do become a little unpredictable and perhaps a good subject of insurance.


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