@trang, @hirschey, and I are contemplating a trip to Africa to visit my brother @jhimmel in Liberia. The U.S. Centers for Disease Control and Prevention recommends several vaccines for travelers to Liberia. And the yellow fever vaccine is required before the Liberian consulate will issue a travel visa.
Anyways, I have the University of Pennsylvania Postdoctoral Insurance Plan through Aetna. I messaged my primary care physician at Penn Medicine and her office recommended obtaining the required vaccines through Penn Travel Medicine. Therefore, I messaged Aetna via their website to inquire about whether my Penn insurance would cover this preventative care at Penn's clinic.
The experience was not great and I don't have much more clarity than when I started. For the record and in case this is helpful for anyone else, below is my message transcript with Aetna:
From Me to Aetna on 2019-10-02
Greetings,
I am traveling to Liberia, Africa in February 2020 and have contacted the "Penn Travel Medicine" clinic for vaccinations. This clinic does not accept insurance. Instead patients pay directly and must submit claims to insurance for reimbursement.
According to the CDC recommendations, I may need one or more of the following vaccines (I've included the Penn Travel Medicine pricing for each):
- $220 for yellow fever
- $400 rabies for each of 3 inoculations
- $120 hepatitis A for each of 2 inoculations
- $100 hepatitis B for each of 3 inoculations
- $130 typhoid fever
Furthermore, the consultation fee required to visit the clinic is $85.
Can you inform me what amount of the above expenses are covered by my insurance plan? According to my math, if all vaccinations listed above are deemed necessary, the total cost would be $2,175. Assuming proper documentation, how much of this will Aetna reimburse?
From Aetna to me on 2019-10-03
From: Member Services
Dear Daniel Himmelstein:
Thank you for using your secure member website to contact Aetna. To help protect your confidential information, please continue to use the link 'Contact Us' to send a message. This online form provides greater security than standard Internet email.
Determining coverage
Coverage for services is based on your plan and certain clinical criteria called a Clinical Policy Bulletin (CPB). Please be sure to review and discuss the CPB with your doctor.
Finding a Clinical Policy Bulletin (CPB)
- Under Plans, click on the 'View Coverage' for Medical.
- Scroll down to the section called "Some Helpful Information" and click on 'Find a Clinical Policy Bulletin'.
- Choose one the options of Medical, Dental or Pharmacy Clinical Policy Bulletins.
- Click the 'I Accept' button.
- You can search by Alphabetical, Numerical, a keyword or with the policy number '0473'.
- Click 'Go'.
The information provided above is not a guarantee of coverage. Coverage is based on all the terms and conditions of your plan as well as eligibility at the time services are received.
Your plan covers immunizations administered by participating providers at 100% of the network negotiated charges with no deductible
Submitting a claim
You can submit a claim for reimbursement. Please send us an itemized bill including the following information:
- Diagnosis code
- Description of services performed or a billing code
- Date of service
- Federal Tax Identification Number (from treating doctor or facility)
- Billing and servicing address
- Patient name
- Receipt showing payment
You can send your claim to us several ways:
- Mail your information to the address on the claim form or to the address located on the back of your ID card.
- Fax your claim to us at: 1-866-474-4040.
- Use the 'Contact Us' link, attach your claim form and email it to us.
If you need a claim form
- On your home page, click the 'Documents & Forms' link at the top.
- To the left; choose the type of forms you wish to view.
- Scroll and click to open a PDF copy of the form you want to view and print.
Remember, if you use an in-network Doctor, they will submit claims for you.
If you have additional questions, send us a 'Contact Us' message or call the toll-free number on your member ID card, if applicable.
Sincerely,
Aetna Internet Response Team
41316208
From Me to Aetna on 2019-10-03
Please see the attached file 2019-10-03_aetna-message-reply.pdf for my reply, which exceeded the max character count for this message box.
Side note for the technical team: it's a bad implementation to silently truncate pasted text. At least give a warning that the max character count has been reached, since I almost submitted a partial message. Also I found that it's essential to compose the message in an external application because the messaging page logs out after inactivity and renavigates based on activity on other Aetna pages, making it highly unlikely that a complex communication can be composed before getting lost.
Dear Aetna Internet Response Team,
Thanks you for the response and information. I would like to inquire further about the following statement:
Your plan covers immunizations administered by participating providers at 100% of the network negotiated charges with no deductible
I am wondering whether the travel immunizations listed in my first message would be reimbursable if provided by Penn Travel Medicine. Penn Travel Medicine is the clinic recommended by my in-network primary care physician. However, they do not accept insurance. Instead patients pay via credit card. Hence, I assume they are not a “participating provider” with “network negotiated charges”.
Based on your advice, I read the Vaccines for Travel bulletin. This document includes all the vaccines I potentially need, which are CDC recommended for certain travellers to Liberia. It also describes the “medically necessary indications”, which from my reading cover at-risk individuals in their travel to Liberia.
From the document “Summary of Benefits & Coverage: Standard Supplemental Information”, I found the following:
The following is a partial list of services and supplies that are generally not covered ... Immunizations for travel or work except where medically necessary or indicated.
Does this mean that travel related immunizations that are medically necessary / indicated are covered by my plan?
In short, I am back to asking my original question. If I go to Penn Travel Medicine and get the medically-necessary immunizations listed in my first message for a total cost of $2175, how much, if any, of this amount is reimbursable?
Based on my plan, will Aetna reimburse 100% of immunization costs at the prices listed in my first message, even though the provider is potentially out-of-network? If not what is the maximum reimbursable amount for each of the immunizations?
From Aetna to Me on 2019-10-03
From: Member Services
Dear Mr. Himmelstein:
Thank you for using your secure member website to contact Aetna. To help protect your confidential information, please continue to use the link 'Contact Us' to send a message. This online form provides greater security than standard Internet email.
Your suggestion
Thank you for your feedback on our website. We're continuously working to enhance it by adding new and improved features over time. We apologize for the inconvenience caused.
Your plan excludes coverage for immunizations solely for the purpose of travel.
Therefore, there would be no benefits available for immunizations performed solely for the purpose of travel.
Your request
Penn Travel Medicine does not participate in your Aetna health plan. You can search for an in-network doctor in your secure member website.
Using Find Care
The search feature prefills your plan and zip code to help you find in-network care faster. You can search by name, specialty or category.
Finding a doctor
- Click the 'Find Care' tab.
- Then enter the type of provider you are looking for into the search box.
- Several choices may appear. Choose the option you want to see by clicking the arrow to the right to view in-network providers in your area.
Searching in a different zip code
- Click in the box where your registered town and state are located.
- Enter the new zip code or city information and then click 'Apply'.
- Re-click on the arrow to get your list of in-network providers in the new search area.
Note: Some doctors can work in several offices. If you plan to see a doctor at a different office than you normally would, make sure to check they are in-network at that location.
If you have additional questions, send us a 'Contact Us' message or call the toll-free number on your member ID card, if applicable.
Sincerely,
Aetna Internet Response Team
41322555
Conclusion
In the last message Aetna claims they will not cover the immunizations if they're solely for the purpose of travel. I think this is bad policy since it makes preventative care expensive. It's disappointing that the one of the few times I actually need my health insurance, it seems that it won't apply.
Also I am still not sure where to find the contractual agreement that indicates whether the vaccines should be covered. I guess I should submit the claim and see what happens? In the meantime, I've been working to assemble a spreadsheet of all my inoculations throughout my life and looking into other health care providers with lower costs.
Oh man, I am so sorry to hear that... $2,175 for vaccinations? That´s insane. Some of those are completely free here in the Czech Republic and the rest (combined) is not more than a hundred bucks I would say. Anyway, safe travels and enjoy your trip to Africa!
Yes, and it's not like the extra expense of U.S. healthcare is going towards a better patient experience. As the above situation shows, it's quite unclear and frustrating to try to navigate the medical system.
Some of the exorbitant cost does go to pharmaceutical companies, and therefore helps fund research & development of new therapies. But far too much of it goes to bureaucracy and administration due to an industry that is as convoluted and inefficient as it can get.
Well, honestly, the US healthcare doesn´t have a good reputation in Europe and I even heard of some really bizarre and controversial theories related to it but I don´t really have enough relevant information or experience to be able to make a decent opinion on it. However, your latest experience as described here is quite disappointing. Mildly put.
All done
Here's an update now that this is all settled.
I went to the Dartmouth-Hitchcock International Travel Clinic rather than Penn Travel Medicine. Foremost, the DHMC Travel Clinic did submit claims to insurance and seemed to provide a better customer experience overall.
My Aetna insurance ended up covering the "Clinic Visit" and "Preventative Care Services" categories, but not "Pharmacy". See the statement below:
Therefore, I received a bill for $331.43. This consisted of the following two items:
Note however that the DHMC Travel Clinic has a separate price for procedures that are "uninsured or non-covered", and we had a print-out of the à la carte "Travel Clinic Prices" table to prove it.
I called Conifer Health Solutions at (844)808-0730, which is the entity that takes care of DHMC billing. They were under the impression that the uninsured discount was all or nothing and couldn't be applied to specific non-covered procedures. I mentioned that the price menu indicated otherwise. They had me email my documentation to
[email protected].I never got a reply to my email, but followed up with another call. This led to my balance decreasing by a $192.89 adjustment. So in total I paid $168.54 ($138.54 + $30 copy). Not bad for yellow fever and typhoid fever!
But the experience shows just how much time the arcane medical billing and insurance system wastes, invariable driving medical inflation. Also Aetna really should cover all preventative vaccinations.
Notes for the future: I do think it makes sense to submit your claim, even if the medical provider does not. Never know what the insurance will end up covering.
Here's what the claim looks like on the Aetna website (my insurance):
Note the following under the vaccines:
In total, Aetna only paid $100.53 to DHMC.
@tipu curate
Thanks @schmidt2015 for your interest and support of this post. I always enjoy posting random info that may be useful to some people on the blockchain.
Many thanks! @dhimmel
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Very disappointing that Aetna is not covering the immunization costs. My mom gasped when I told her about the total of $2,175 ( > 50,000,000 Vietnamese dong).
Wow that is a lot of dong!
I think this should be useful and today I wanna tell you about the https://traveldefend.com/ website where you can get travel insurance if you ever plan to go anywhere. I would like to tell you about this and thanks for the post here.
Thanks as always for your diligent text to speech services!