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Subject: Health Insurance Doublespeak - What does this mean? rss

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Andrew Lloyd
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My wife and I are traveling overseas and need to get travel immunizations. I called my insurance company to see if they are covered and they said that they are covered 100%. Now I'd say about 50% of the time, the phone reps are full of shit and have no idea what they are talking about so I was finally able to pull up my plan documentation.

It divides immunizations into 2 sections: Those given during routine annual physical and those not part of a physical. For the former, it says 100% coverage, no deductible. For the later, it says: Payable in accordance with the type of expense incurred and the place where service is provided." What the hell does that mean? I called back and they insisted that meant 100% coverage but then why doesn't it just say that in the first place?
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Richard Hedke
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clawlan wrote:
... but then why doesn't it just say that in the first place?


Because that wouldn't not be unclear.
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fightcitymayor
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clawlan wrote:
It divides immunizations into 2 sections: Those given during routine annual physical and those not part of a physical. For the former, it says 100% coverage, no deductible. For the later, it says: Payable in accordance with the type of expense incurred and the place where service is provided." What the hell does that mean? I called back and they insisted that meant 100% coverage but then why doesn't it just say that in the first place?
Since your routine annual physicals are already covered 100% by your plan, then that is assumed as A-OK. But if you take a special visit to some other doctor/specialist that does god-knows-what in god-knows-where then that is the 2nd part, because your insurer is covering their own ass in case you go to Doctor Seymour Lipshitz and get liposuction, breast implants, botox, chemotherapy, a facelift, and a prosthetic arm... and oh by the way why don't you just toss in some immunizations while you're at it! They won't pay for the other procedures, but the immunizations should still be A-OK.

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Andrew Lloyd
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fightcitymayor wrote:
and a prosthetic arm...


i find this particularly funny b/c i do have a prosthetic arm and they are covered in my insurance. those things are expensive (>$10,000)
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Andrew Lloyd
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Koldfoot wrote:
I'd bet the fee for a routine physical is a cheaper visit.

The insurance company probably wants to encourage those visits instead of special appointments.

Pay cash. Why stress?


Yea, after talking to one of my coworkers that does a lot of traveling, most primary care docs do the immunizations and submit to your insurance as per normal so there is no out of pocket. My current PCP does not for some reason so i am going to switch to a different one.

If we were talking about a little $25 flue shot, then i would just pay and be done with it but the ones I need are >$1000 for my wife and I.
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Sebastián Koziner
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clawlan wrote:
Payable in accordance with the type of expense incurred and the place where service is provided." What the hell does that mean? I called back and they insisted that meant 100% coverage but then why doesn't it just say that in the first place?


It means that if you give yourself immunization in your area it got covered, but if you go somewhere else it won't
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jonathan lundberry
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clawlan wrote:
"Payable in accordance with the type of expense incurred and the place where service is provided."


This is to cover them in case you go to an out of network facility. If you go to an in network physician they have negotiated pricing so they are basically saying if you go to your favorite "out of network" clinic then expect to not be covered 100%.
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