Commentary: The conundrum of getting a flu shot

11/05/2013 12:00 AM

08/08/2014 10:19 AM

You really should get a flu shot.

But if you get one at a drugstore, you might find yourself wondering whether they’re playing fast and loose with people’s insurance coverage so the company can score some extra cash.

Paul Rubenstein, 39, has faced such a possibility for two years. The Mar Vista, Calif., resident is insured by Anthem Blue Cross. His wife is insured by Health Net.

Last year, they went to a local CVS store for flu shots. The pharmacy worker ran both their insurance cards through the computer and said that neither insurer was covering vaccinations.

So Rubenstein and his wife paid about $30 each for the shots and went on their way.

This year, he decided to check in advance. Rubenstein called Anthem to ask whether he was covered for a flu shot. A company rep answered that, yes, he was covered.

So Rubenstein recently visited a nearby Albertsons and requested a shot at the store’s Sav-On drugstore. The worker ran his insurance card through the system and said it didn’t look as if Rubenstein was covered.

It was only after Rubenstein insisted that his insurer covered flu shots that the store worker tried the card again and, lo and behold, this time it showed he was covered.

An Anthem spokesman confirmed for me that flu shots are covered at most retail pharmacies.

Rubenstein said he later shared his experience with a colleague, who responded that she, too, had been told that her insurance didn’t cover flu shots.

In her case, it was a Rite-Aid worker making the claim, and, as with Rubenstein, the pharmacy worker somehow managed to discover that coverage existed only after the woman stood her ground.

At this point, I’d be prepared to chalk all this off to coincidence. But then the same thing happened to me.

I stopped by a CVS store in West Los Angeles and requested a flu shot. I had been getting mine at CVS for the past few years, and each time it had been covered by my company’s health insurer.

Not this time. The pharmacy worker checked the system and said that neither I nor my wife was covered for flu shots. If we wanted them, we’d have to pay about $30 each.

I contacted my insurer. A company rep was confused by the situation. “You’re definitely covered for flu shots,” she said. “CVS shouldn’t be a problem.”

So I went to a different CVS, this one with a so-called MinuteClinic staffed by a nurse practitioner. She ran my insurance card through the system and – what do you know? – it showed I was covered.

Should it make a difference whether someone seeks a flu shot from a CVS pharmacy or from a MinuteClinic? It shouldn’t. They’re both owned by the same parent company, CVS Caremark.

But Mike DeAngelis, a CVS spokesman, said the company’s drugstores and MinuteClinics “are two separate practice settings and they contract for flu shot coverage separately.”

“While many insurance plans are accepted by both CVS pharmacy and MinuteClinic for flu vaccinations, it is not uncommon for there to be some differences,” he said.

DeAngelis emphasized that it’s up to insurers and employers to select “a covered practice setting,” even if those two practice settings are owned by the same company and are under the same roof.

It’s possible this is nothing more than another example of the dysfunctional nature of our healthcare system. Perhaps the only problem here is that the various players involved in the delivery of something as benign and commonplace as a flu shot can’t get their respective acts together.

Or maybe, just maybe, drugstores have discovered that many people will pony up cash for a flu shot if they’re told their insurance isn’t working. And maybe, just maybe, drugstores were hoping no one would notice a proliferation of these “honest mistakes.”

In any case, a lot of people think they don’t have to bother with a flu shot, or that they don’t work. I encounter people every year who say they received a shot but got sick anyway.

There’s something to this. In any given year, flu vaccines represent a best guess by researchers as to what flu strains are expected to hit us in the winter. Sometimes they can figure out in advance which ones pose the greatest threat to people. Sometimes they can’t.

And even then, vaccines won’t work the same for everyone. A flu shot might have a greater effect on someone who is young and healthy, but relatively little effect on someone older or with a compromised immune system.

According to the Centers for Disease Control and Prevention, you can still get sick even if you’re vaccinated. But your chances of being hospitalized or catching pneumonia are significantly reduced.

The CDC recommends flu shots for everyone over the age of 6 months, but particularly for people with chronic conditions, pregnant women, seniors and caregivers for others.

And in answer to a common question, the CDC says flu shots can’t make you sick because they don’t contain live viruses.

Plus, there’s an added benefit: A recent report in the Journal of the American Medical Association found that getting a flu shot can reduce your likelihood of a serious heart problem by 36 percent.

Experts aren’t sure why that is, but it’s a nice perk.

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