Navigating the Insurance Company Maze

The last time I went to my primary care doctor, (hereinafter referred to as my PCDr) for a checkup, she told me that I should consider getting the shingles vaccine. I am 63 and, because I had chicken pox as a child, the shingles virus lies dormant in my body and can flare up at any time, causing various and sometimes severe symptoms including permanent nerve damage. (https://www.google.com/health/ref/Herpes+zoster).

I didn't think very much about doing this until I got a letter from my insurance company, (hereinafter referred to as Big Nameless Insurance Company, or BNIC) saying that the shingles, or Zostavax vaccine, would now be covered, a change from past policy. So, I decided to get the vaccine.

My PCDr gave me a written prescription at my last visit and said to get the prescription filled and bring it to her and she would inject the vaccine. Having been burned before when procedures I thought would be covered by my BNIC actually weren't, I called BNIC. They said they would not cover that. They suggested that my PCDr order the vaccine and that I go to her to get the vaccine injected. The PCDr said no go to that, and suggested that I go to the county health department to get the injection.

I called BNIC to see if that would be covered. The gentleman in customer service said that it would not be covered, since the county health department is an out-of-network provider. The customer service rep suggested that I find another PCDr in the network who would inject the vaccine in his/her office.

I find another doctor in the network, call his office, and ask if I can get the vaccine there. His office also suggests that I get it from the county health department. I said that I already tried that and was told that the county health department was out of network and the cost would not be covered. I decide that I have nothing to lose, and call BNIC again. This time I get another customer service representative, who calls the county health department while I am on the phone with her, and we end up having a 3 way conversation.

This customer service rep tells me that, in fact, the vaccine would be covered if I got it at the county health department. She apologized and said that the CS rep I spoke to previously had given me incorrect information.

After a brief telephone pre-screening interview by the county health nurse, I am told that I can come in anytime in the next 2 weeks to get the vaccine. I do that, and aside from some temporary redness and swelling at the site of the injection, all is fine. I am protected from shingles for the next 6 years. I have successfully navigated the insurance company maze and come out on top. Hooray for me.

But, what about other people in the same situation I was in? I am persistent, literate, and fluent in English. I have the time to devote to getting answers to all my health care questions. What about people who don't have time to pursue all their options because they are working two or more jobs to make ends meet? Who might not be proficient in English, or whose literacy skills might not be up to par?

Our health care system needs to serve every one equally, however that might be accomplished. Navigating the health care maze shouldn't be as difficult as I found it to be.