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What to do if Immunization is Not Covered by Health Plan

July 1, 2009 | Healthcare | My Ramblings | 2 Comments

immunization

My wife and I just had a beautiful baby boy!  We recently had him vaccinated which we thought was covered by our insurance company, United Health Care (UHC).  To our surprise the claim was denied because UHC doesn’t cover immunization.  For 6 shots the doctor’s office billed us $565, which averages $94.17 per shot.  There is no way I was paying $565 for 6 common immunization shots.

After doing some research I found out that the state of Georgia offers the shots for free if you can prove your insurance company doesn’t cover immunization or you don’t have insurance.  This is why I think UHC doesn’t cover immunization; they know the state will.  However, they should do a better job of notifying their customers of this.

I then called the doctor’s office to complain about the bill and I was told if I had notified them that my insurance company didn’t cover immunization, the shots would have been pulled from the Medicaid stock which would have only cost $10 per shot.  (What the bleep!)  The clerk stated it was too late to reverse the charges and use the Medicaid charges.  She however discounted the bill by $130 which wasn’t enough.  

I told the clerk that was unreasonable and that I’d write a letter to the doctor (see letter below).  Well the letter worked.  I received a call from the doctor’s office yesterday saying the bill would be adjusted to costing only $10 per shot.  

One thing I’ve learned is to never let people take advantage of you.  This is also why we need Healthcare Reform in this country!  

See letter below of letter to the doctor’s office:

 

P. Birmingham
XXXX XXXXX XXX
XXXXXXXX, XX XXXX
XXX-XXX-XXX
XXX-XXX-XXX
June 22, 2009

Dr. XXXXX  XXXXXX
XXX
XXX XXXXXXXXX XXXXX
XXXXXXX, XX XXXXXX

Dear Dr. XXXXX  XXXXXX:

I am writing in regards to the bill (Statement #9149) received from your company for immunization shots given to our son (XXXXXX Birmingham) born on XXXXX XX, 2009.

To our surprise the immunization shots aren’t covered by our insurance company; United Health Care (UHC).  However, charging us $565 for 6 immunizations is outrageous!  If we had known UHC wouldn’t cover the shots, we could have gotten the shots for free from the state.  I realize as a courtesy most medical offices check with a patient’s insurance company first for coverage before giving medical services and I wished your medical office would have done this for us.

I spoke to Vicky in billing about this issue and she stated had we notified her that our insurance company didn’t cover the immunization shots; the shots could have been pulled from the Medicaid stock which would have only cost $10 per shot costing $60 instead of $565.   She stated it was too late to reverse the charges and use the Medicaid charges which I find unreasonable.  She however discounted the bill by $130 which isn’t enough.  

I am requesting that our account be adjusted with the $10 per shot.  If you have any questions please call me at XXX-XXX-XXXX.

Sincerely,

 

 

 

P. Birmingham

 

 

 

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2 Comments to “What to do if Immunization is Not Covered by Health Plan”

  1. Can’t Get Help with a Problem, then Write the CEO - Part II | Money Cake
    11:27 pm on January 5th, 2010

    […] Get Help with a Problem, then Write the CEO“.   I also wrote a post titled “What to do if Immunization is Not Covered by Health Plan“.  Both these posts were about problems I had with a company and how writing a letter to […]

  2. Can’t Get Help with a Problem, then Write a Letter | Money Cake
    11:05 am on February 26th, 2010

    […] What to do if Immunization is Not Covered by Health Plan Share and Enjoy: […]

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