Author Topic: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist  (Read 1949 times)

jeromedawg

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Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« on: September 04, 2018, 12:45:35 PM »
Hey all,

So I'm looking at getting our flu shots done at our local Target Pharmacy because they offer a $5 gift card when you do it there and they also advertise "no-cost flu shots" but according to terms of your medical plan. Apparently the pharmacist will administer the shot as well. I checked with my provider (Anthem BCBS) and they stated that flu shots administered only by "licensed medical professionals" are covered and that pharmacists are not considered "licensed medical professionals" - I'm not sure how that even makes sense given that if pharmacists are administering these shots, they are licensed in some way to do so. So what's the difference?

Cranky

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #1 on: September 04, 2018, 04:01:45 PM »
You should ask at Target.

If I get my flu shot at the doctor's office, the flu shot is free, but I have to pay for the injection, as an office visit.
If I get the flu shot at CVS, there's no co-pay.

Target will know how BCBS handles this.

jeromedawg

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #2 on: September 04, 2018, 04:49:39 PM »
You should ask at Target.

If I get my flu shot at the doctor's office, the flu shot is free, but I have to pay for the injection, as an office visit.
If I get the flu shot at CVS, there's no co-pay.

Target will know how BCBS handles this.

I called them and they ran my insurance and said there's no co-pay. However, I'm on HSA so there's never a co-pay - there's always co-insurance where they bill you after the fact. I contacted Anthem again and they confirmed my suspicion that if I do the flu shot at Target, because it's "pharmacist administered" I would be billed whatever the cost is after the fact - I think this would go against my deductible but why would I want to risk doing that when I know I can get it free from the doctor? The whole thing was based on the premise of my wife and I both getting our shots done at Target so we could get the Targets GCs. Looks like it isn't worth the risk and trouble though. So we're just going to get them at our doctors. Per Anthem, I believe the doctor's visit for the flu shot will be covered in full (I believe the doctor would just need to bill it as a "preventative" visit)

Dr.Jeckyl

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #3 on: September 04, 2018, 05:09:23 PM »
Hey all,

So I'm looking at getting our flu shots done at our local Target Pharmacy because they offer a $5 gift card when you do it there and they also advertise "no-cost flu shots" but according to terms of your medical plan. Apparently the pharmacist will administer the shot as well. I checked with my provider (Anthem BCBS) and they stated that flu shots administered only by "licensed medical professionals" are covered and that pharmacists are not considered "licensed medical professionals" - I'm not sure how that even makes sense given that if pharmacists are administering these shots, they are licensed in some way to do so. So what's the difference?

I have BCBS and my wife and I typically get our flu shots at Walgreen's. No co-pay, no bill after the fact, no nothing, just a quick and easy flu shot. Now if only we could get our 7yo to not freak out when he gets his. He's like the Hulk when they try to give him a shot. It took two nurses and myself to hold him down last year.

nereo

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #4 on: September 04, 2018, 05:39:32 PM »
You should ask at Target.

If I get my flu shot at the doctor's office, the flu shot is free, but I have to pay for the injection, as an office visit.
If I get the flu shot at CVS, there's no co-pay.

Target will know how BCBS handles this.

I called them and they ran my insurance and said there's no co-pay. However, I'm on HSA so there's never a co-pay - there's always co-insurance where they bill you after the fact. I contacted Anthem again and they confirmed my suspicion that if I do the flu shot at Target, because it's "pharmacist administered" I would be billed whatever the cost is after the fact - I think this would go against my deductible but why would I want to risk doing that when I know I can get it free from the doctor? The whole thing was based on the premise of my wife and I both getting our shots done at Target so we could get the Targets GCs. Looks like it isn't worth the risk and trouble though. So we're just going to get them at our doctors. Per Anthem, I believe the doctor's visit for the flu shot will be covered in full (I believe the doctor would just need to bill it as a "preventative" visit)

I have BCBS with a HSA plan (preferred 6500) and there's never been any charge at CVS.  When I was living abroad and paid out of pocket for the flu shot the cost was something like $35.

If it were me I'd just get the shots done at Target, get the $5 GC, and assume/hope you won't get any additional bill.  The problem going to your PC to get the shot is that the visit itself can be billed, even though 'preventative care' (the shot itself) is covered.  You might get him/her to code it as 'preventative' but if not you'll pay more than the $35 you'd pay at Target, plus no $5GC. 
Just my 2˘

jeromedawg

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #5 on: September 04, 2018, 08:09:41 PM »
You should ask at Target.

If I get my flu shot at the doctor's office, the flu shot is free, but I have to pay for the injection, as an office visit.
If I get the flu shot at CVS, there's no co-pay.

Target will know how BCBS handles this.

I called them and they ran my insurance and said there's no co-pay. However, I'm on HSA so there's never a co-pay - there's always co-insurance where they bill you after the fact. I contacted Anthem again and they confirmed my suspicion that if I do the flu shot at Target, because it's "pharmacist administered" I would be billed whatever the cost is after the fact - I think this would go against my deductible but why would I want to risk doing that when I know I can get it free from the doctor? The whole thing was based on the premise of my wife and I both getting our shots done at Target so we could get the Targets GCs. Looks like it isn't worth the risk and trouble though. So we're just going to get them at our doctors. Per Anthem, I believe the doctor's visit for the flu shot will be covered in full (I believe the doctor would just need to bill it as a "preventative" visit)

I have BCBS with a HSA plan (preferred 6500) and there's never been any charge at CVS.  When I was living abroad and paid out of pocket for the flu shot the cost was something like $35.

If it were me I'd just get the shots done at Target, get the $5 GC, and assume/hope you won't get any additional bill.  The problem going to your PC to get the shot is that the visit itself can be billed, even though 'preventative care' (the shot itself) is covered.  You might get him/her to code it as 'preventative' but if not you'll pay more than the $35 you'd pay at Target, plus no $5GC. 
Just my 2˘

Do you use MinuteClinic? If so, that *is* covered because usually the shot would be administered by a nurse and not the pharmacist at that point. There are MinuteClinics in Targets in some locations but not in CA. Anyway, there must be some way they code or bill the shots if administered by a pharmacist versus doctor versus nurse. If administered by "pharmacy" they probably disregard it as a covered service even if it's considered preventative. That's my guess at least. I checked with my doctor's office and they bill the visit as "preventative" AFAIK. I got my shot done there last September and wasn't billed for it. Was just hoping to get in on the $5 GC but it's not that big of a deal.

Spiffy

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #6 on: September 05, 2018, 11:00:24 AM »
We have BCBS in Texas and for several years now we have gotten flu shots at Target. My kids actually look forward to it because I let them spend the $5 gift card right then (CANDY!). We have never been charged anything for them.

jeromedawg

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #7 on: September 06, 2018, 06:46:54 PM »
We have BCBS in Texas and for several years now we have gotten flu shots at Target. My kids actually look forward to it because I let them spend the $5 gift card right then (CANDY!). We have never been charged anything for them.

HSA though? I'm wondering if there's a discrepancy based on the type of plan you have. If HRA/HMO/PPO they may not really care too much and will cover anything whereas with HSA they might be more particular. It's super confusing either way...

Rural

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #8 on: September 06, 2018, 08:55:14 PM »
If your insurance company says they will charge you, believe them.

Spiffy

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #9 on: September 07, 2018, 11:41:10 AM »
We have BCBS in Texas and for several years now we have gotten flu shots at Target. My kids actually look forward to it because I let them spend the $5 gift card right then (CANDY!). We have never been charged anything for them.

HSA though? I'm wondering if there's a discrepancy based on the type of plan you have. If HRA/HMO/PPO they may not really care too much and will cover anything whereas with HSA they might be more particular. It's super confusing either way...
No. We don't have HSA, so yours may not be the same. Didn't think about that.

FallenTimber

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Re: Flu Shot coverage - "Licensed Medical Professional" vs Pharmacist
« Reply #10 on: September 07, 2018, 02:06:29 PM »
We use Safeway because they give a 10% off coupon for groceries. We’ll usually do a big trip to stock up and save $20 using the coupon. Just another option to consider.