Grocery store didn't tell me Shingrix was $160

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TravelGeek
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Re: Grocery store didn't tell me Shingrix was $160

Post by TravelGeek »

Faith20879 wrote: Thu Sep 17, 2020 9:12 am
LadyIJ wrote: Wed Sep 16, 2020 1:16 pm Just wanted opinions:
... I think they should have told us in the two weeks or even that day, not afterwards.
I can certainly relate. DH just got his first shot a week ago. CVS had his ins. info and said "today's shot is free (covered). ". Now that was before he informed us that there is a 2nd shot involved. When everything was done, he mentioned the booster within 6 months. We just assumed that will be free too. From your experience, we may have assumed wrong.

If when we go back and indeed be asked to pay 160 for the booster shot, I probably will not feel too bad because you have prepared me. If I had not read it here, I would probably feel like you for a few days then pay and move on.
I think it is highly unlikely that your insurance will pay for the first shot and not the second one.
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Abe
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Re: Grocery store didn't tell me Shingrix was $160

Post by Abe »

egrets wrote: Wed Sep 16, 2020 2:36 pm Medicare.gov says Plan Ds cover Shingrix.
Yes it's covered, but my part D with Humana only covered a small part of the cost, so my out of pocket cost was still a lot.
Slow and steady wins the race.
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

Almost nothing I get done via healthcare do they "tell" me the price upfront. That includes x-rays, CT scans, MRIs, lab tests, prescriptions (they tell me at the register when it is time to pay), etc . Like anything, if you are concerned about the price, ask.

I just got an EOB yesterday from a lab test in February saying it was out of network. Well, I have no control really where my doctor sends this stuff. Most of the lab work was covered but I am guessing this particular test isn't offered by their main lab. Navigating all of it is not easy.
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cheese_breath
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Re: Grocery store didn't tell me Shingrix was $160

Post by cheese_breath »

Abe wrote: Thu Sep 17, 2020 9:47 am
egrets wrote: Wed Sep 16, 2020 2:36 pm Medicare.gov says Plan Ds cover Shingrix.
Yes it's covered, but my part D with Humana only covered a small part of the cost, so my out of pocket cost was still a lot.
Had you met your deductible first?
The surest way to know the future is when it becomes the past.
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

Normchad wrote: Wed Sep 16, 2020 3:44 pm
Broken Man 1999 wrote: Wed Sep 16, 2020 3:33 pm I'll be paying $20 to get the first shot tomorrow at Publix.

So far as OP's issue:
1. The price of $160 doesn't seem to be a rip-off price at all (which OP is NOT suggesting), so that was good.
2. I subscribe to the notion that I am the only one responsible for looking out for WHERE my dollars and HOW MANY of them choose to leave me. No one looks out for me better than me.

But, that's just me.

Broken Man 1999
I see what you are saying. But this is not the OPs fault, it is the system.

Suppose your grocery store called you up at night, and said there was now a special $500 fee for the cake frosting you bought earlier that day? Would we all be okay with “well, you should have asked if there were any special cake frosting fees?”

Of course not, that is preposterous. Every other item in that store is required by law to display the price. There is a reason the prices need to be shown. It’s complete crap that the pharmacy couldn’t figure this out and tell the OP at the point of service. (My grocery store did).

If I was the OP, I wouldn’t pay it. Wait a few months and see what happens.

You seem to be missing that $160 seems to be the going rate for this shot as many people have chimed in. $500 for a cake frosting is not anything I've every heard of.

It isn't really hard to say "how much will this shot cost"? Though the system may be a mess, that isn't really hard in this instance. If you ask a hospital how much a surgery will cost that is a whole other issue.

The OP's spouse got the first shot for free at the VA, for whatever reason didn't want to bother going to get it for free for the 2nd shot, didn't ask the price and then is complaining for having to pay market price of the shot IMO.
getthatmarshmallow
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Re: Grocery store didn't tell me Shingrix was $160

Post by getthatmarshmallow »

So, this is something to keep in mind for the future regarding vaccinations, but I also want to say that it's often impossible to figure out what costs are going to be until after they're billed. Insurance says "you're responsible for ensuring that your doctor/hospital/etc is in network."; Doctor's office says "we don't generate the billing code until after the procedure is done" or "We outsource the billing" or "well, the surgeon is definitely in network but we have no idea who the anaesthesiologist will be until that day".... And that's without considering emergency situations where one is not in a position to price shop.

So you get stuck in this loop of the insurance not being able to tell anything without the code, and the doctor not knowing the code or quite reasonably not knowing what the code will be. A market only works with price transparency.
RXfiles
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Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
Last edited by RXfiles on Thu Sep 17, 2020 10:40 am, edited 1 time in total.
Sconie
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Re: Grocery store didn't tell me Shingrix was $160

Post by Sconie »

MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
I know you think you understand what you thought I said but I'm not sure you realize that what you heard is not what I meant. - Alan Greenspan
Normchad
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Re: Grocery store didn't tell me Shingrix was $160

Post by Normchad »

michaeljc70 wrote: Thu Sep 17, 2020 10:00 am
Normchad wrote: Wed Sep 16, 2020 3:44 pm
Broken Man 1999 wrote: Wed Sep 16, 2020 3:33 pm I'll be paying $20 to get the first shot tomorrow at Publix.

So far as OP's issue:
1. The price of $160 doesn't seem to be a rip-off price at all (which OP is NOT suggesting), so that was good.
2. I subscribe to the notion that I am the only one responsible for looking out for WHERE my dollars and HOW MANY of them choose to leave me. No one looks out for me better than me.

But, that's just me.

Broken Man 1999
I see what you are saying. But this is not the OPs fault, it is the system.

Suppose your grocery store called you up at night, and said there was now a special $500 fee for the cake frosting you bought earlier that day? Would we all be okay with “well, you should have asked if there were any special cake frosting fees?”

Of course not, that is preposterous. Every other item in that store is required by law to display the price. There is a reason the prices need to be shown. It’s complete crap that the pharmacy couldn’t figure this out and tell the OP at the point of service. (My grocery store did).

If I was the OP, I wouldn’t pay it. Wait a few months and see what happens.

You seem to be missing that $160 seems to be the going rate for this shot as many people have chimed in. $500 for a cake frosting is not anything I've every heard of.

It isn't really hard to say "how much will this shot cost"? Though the system may be a mess, that isn't really hard in this instance. If you ask a hospital how much a surgery will cost that is a whole other issue.

The OP's spouse got the first shot for free at the VA, for whatever reason didn't want to bother going to get it for free for the 2nd shot, didn't ask the price and then is complaining for having to pay market price of the shot IMO.
This is a simple transaction at a pharmacy. If they wanted $160, they should have asked for it at the time. Pharmacies deal with insurance all the time. They know how to do this. They screwed up. I’ve never had a call from a pharmacy after the fact saying they need more money.

Would people feel different if the pharmacist called and said it was $3000? It’s no different.

Keep in mind, I got the same vaccine at a grocery store. And twice I paid $160. I have no qualms with paying.

They didn’t advise him of the price, and they let him leave without asking for payment. They screwed up. They should take personal responsibility, own their mistake, and leave the OP alone.
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Abe
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Re: Grocery store didn't tell me Shingrix was $160

Post by Abe »

cheese_breath wrote: Thu Sep 17, 2020 9:58 am
Abe wrote: Thu Sep 17, 2020 9:47 am
egrets wrote: Wed Sep 16, 2020 2:36 pm Medicare.gov says Plan Ds cover Shingrix.
Yes it's covered, but my part D with Humana only covered a small part of the cost, so my out of pocket cost was still a lot.
Had you met your deductible first?
Probably not. It's been a while, so I can't remember the details, but I seem to remember that Humana only paid a small part of the cost, and I had to pay the remainder which was quite a bit. I just recently got my flu shot at Walmart Pharmacy and the pharmacist asked about my shingles shot. I asked her how much it cost, and I think she said around $160. I'm not really sure how much she said it was, but it was more than I wanted to pay. I have Humana Part D that cost $13.20 per month.
Slow and steady wins the race.
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

Normchad wrote: Thu Sep 17, 2020 10:36 am
michaeljc70 wrote: Thu Sep 17, 2020 10:00 am
Normchad wrote: Wed Sep 16, 2020 3:44 pm
Broken Man 1999 wrote: Wed Sep 16, 2020 3:33 pm I'll be paying $20 to get the first shot tomorrow at Publix.

So far as OP's issue:
1. The price of $160 doesn't seem to be a rip-off price at all (which OP is NOT suggesting), so that was good.
2. I subscribe to the notion that I am the only one responsible for looking out for WHERE my dollars and HOW MANY of them choose to leave me. No one looks out for me better than me.

But, that's just me.

Broken Man 1999
I see what you are saying. But this is not the OPs fault, it is the system.

Suppose your grocery store called you up at night, and said there was now a special $500 fee for the cake frosting you bought earlier that day? Would we all be okay with “well, you should have asked if there were any special cake frosting fees?”

Of course not, that is preposterous. Every other item in that store is required by law to display the price. There is a reason the prices need to be shown. It’s complete crap that the pharmacy couldn’t figure this out and tell the OP at the point of service. (My grocery store did).

If I was the OP, I wouldn’t pay it. Wait a few months and see what happens.

You seem to be missing that $160 seems to be the going rate for this shot as many people have chimed in. $500 for a cake frosting is not anything I've every heard of.

It isn't really hard to say "how much will this shot cost"? Though the system may be a mess, that isn't really hard in this instance. If you ask a hospital how much a surgery will cost that is a whole other issue.

The OP's spouse got the first shot for free at the VA, for whatever reason didn't want to bother going to get it for free for the 2nd shot, didn't ask the price and then is complaining for having to pay market price of the shot IMO.
This is a simple transaction at a pharmacy. If they wanted $160, they should have asked for it at the time. Pharmacies deal with insurance all the time. They know how to do this. They screwed up. I’ve never had a call from a pharmacy after the fact saying they need more money.

Would people feel different if the pharmacist called and said it was $3000? It’s no different.

Keep in mind, I got the same vaccine at a grocery store. And twice I paid $160. I have no qualms with paying.

They didn’t advise him of the price, and they let him leave without asking for payment. They screwed up. They should take personal responsibility, own their mistake, and leave the OP alone.
This was not a normal pharmacy transaction. If you read the OP it was done in their car.
Gnirk
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Re: Grocery store didn't tell me Shingrix was $160

Post by Gnirk »

You received the vaccine at its normal price; in fact, mine cost a bit more. You owe the money, and need to pay it.
The fact that you didn’t ask the price ahead of time is on you. Vaccines aren’t advertised like used cars or appliances.
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BogleFanGal
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Re: Grocery store didn't tell me Shingrix was $160

Post by BogleFanGal »

tibbitts wrote: Wed Sep 16, 2020 6:27 pm
interwebopinion wrote: Wed Sep 16, 2020 2:29 pm What concrete proof do you have of such an agreement? No one agrees to being charged 'any price'. That sounds like a price gouging manifesto.
GmanJeff wrote: Wed Sep 16, 2020 2:10 pm You deliberately agreed to any price charged by consciously soliciting and accepting a product and service while choosing not to inquire into cost in advance.
Agreed, as far as I know virtually everyone receiving any medical service agrees to pay any price. The only choice is to not receive the service.

But it wouldn't have mattered if you had asked. The answer would have been "we don't know, ask your insurance." When you ask the insurance you'll be told "it's up to the provider." So you take your chances no matter what you do and pay what you owe. It was fortunate that the OP had to pay $300 and not $30,000.
This is EXACTLY the conversation I have every single time I try to get a sense of cost on an upcoming visit or prescribed procedure. There always seem to be multiple codes for every single visit or procedure and which code will apply is unknown until after the visit - and then it's often a bear to get those codes corrected if there's been a mistake.

Until there is legally-required obligation and accountability on the part of the provider and insurance company to help inform a patient about costs, we'll always be limited in our ability to take proactive responsibility.

In OP's case, it's a straighfwd vaccination - that one's probably the easiest. Her insurance company could have quoted the cost in a sec, but for procedures, urgent care visits and other more complex things, it's a nightmare.
"Life would be infinitely happier if we could only be born at the age of eighty and gradually approach eighteen." Mark Twain
Katietsu
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Re: Grocery store didn't tell me Shingrix was $160

Post by Katietsu »

HueyLD wrote: Wed Sep 16, 2020 6:51 pm It is surprising to me that the pharmacy did not run the claim thru OP’s insurance first.

My pharmacy always does that and lets me know what my copay is, if any.
I am only speculating here. I think what went wrong is that the pharmacy was trying to do a lower risk Covid event. The vaccination was therefore done at a drive thru/outside event. The regular procedure where the insurance information is put in the computer and the cost discussed with the patient just before the vaccination is administered was not done. The charges were instead entered after the event was over.

There are plans for drive thru influenza vaccine clinics by organizations who have never sponsored a drive thru event. I hope there are not more people who are upset with a surprise charge after the event. Our complex insurance system does not make it easy to manage what is a great attempt at addressing a real need.
RXfiles
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Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

Normchad wrote: Thu Sep 17, 2020 10:36 am
michaeljc70 wrote: Thu Sep 17, 2020 10:00 am
Normchad wrote: Wed Sep 16, 2020 3:44 pm
Broken Man 1999 wrote: Wed Sep 16, 2020 3:33 pm I'll be paying $20 to get the first shot tomorrow at Publix.

So far as OP's issue:
1. The price of $160 doesn't seem to be a rip-off price at all (which OP is NOT suggesting), so that was good.
2. I subscribe to the notion that I am the only one responsible for looking out for WHERE my dollars and HOW MANY of them choose to leave me. No one looks out for me better than me.

But, that's just me.

Broken Man 1999
I see what you are saying. But this is not the OPs fault, it is the system.

Suppose your grocery store called you up at night, and said there was now a special $500 fee for the cake frosting you bought earlier that day? Would we all be okay with “well, you should have asked if there were any special cake frosting fees?”

Of course not, that is preposterous. Every other item in that store is required by law to display the price. There is a reason the prices need to be shown. It’s complete crap that the pharmacy couldn’t figure this out and tell the OP at the point of service. (My grocery store did).

If I was the OP, I wouldn’t pay it. Wait a few months and see what happens.

You seem to be missing that $160 seems to be the going rate for this shot as many people have chimed in. $500 for a cake frosting is not anything I've every heard of.

It isn't really hard to say "how much will this shot cost"? Though the system may be a mess, that isn't really hard in this instance. If you ask a hospital how much a surgery will cost that is a whole other issue.

The OP's spouse got the first shot for free at the VA, for whatever reason didn't want to bother going to get it for free for the 2nd shot, didn't ask the price and then is complaining for having to pay market price of the shot IMO.
This is a simple transaction at a pharmacy. If they wanted $160, they should have asked for it at the time. Pharmacies deal with insurance all the time. They know how to do this. They screwed up. I’ve never had a call from a pharmacy after the fact saying they need more money.

Would people feel different if the pharmacist called and said it was $3000? It’s no different.

Keep in mind, I got the same vaccine at a grocery store. And twice I paid $160. I have no qualms with paying.

They didn’t advise him of the price, and they let him leave without asking for payment. They screwed up. They should take personal responsibility, own their mistake, and leave the OP alone.

That's not how it works. OP received a good or service they owe the money. Thats the price of the shot. Its not the pharmacies fault it wasn't covered. OP screwed up by not making sure it was covered or how much it costs. Services were rendered OP has to pay. The pharmacy isn't price gouging.

They would 100% lose if they took it to any type of small claims court. Chalk it up as a 160 dollar lesson and move on.
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cheese_breath
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Re: Grocery store didn't tell me Shingrix was $160

Post by cheese_breath »

Sconie wrote: Thu Sep 17, 2020 10:34 am
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
Vastly different. As different as shingles are from flu.
The surest way to know the future is when it becomes the past.
tibbitts
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Re: Grocery store didn't tell me Shingrix was $160

Post by tibbitts »

RXfiles wrote: Thu Sep 17, 2020 10:24 am Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
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Abe
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Re: Grocery store didn't tell me Shingrix was $160

Post by Abe »

I learned something a long time ago. Always ask in advance how much something cost. Having said that, I realize that in some cases you can't know exactly how much something will cost like a doctor visit, etc. But you should always be able to find out how much something like a shingles shot will cost if you ask. That way there will be no surprises.
Slow and steady wins the race.
RXfiles
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Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

tibbitts wrote: Thu Sep 17, 2020 11:07 am
RXfiles wrote: Thu Sep 17, 2020 10:24 am Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.

I wouldn't be surprised if they handed OP something with the price on it before they received the vaccine and now they have remorse bc they could have gotten it for free elsewhere. You dont make it thru a vaccine at a pharmacy with no paperwork exchanged. OP had to sign papers and everything. Just reeks of a typical karen customer service issue.
Last edited by RXfiles on Thu Sep 17, 2020 11:28 am, edited 1 time in total.
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

RXfiles wrote: Thu Sep 17, 2020 11:12 am
tibbitts wrote: Thu Sep 17, 2020 11:07 am
RXfiles wrote: Thu Sep 17, 2020 10:24 am Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered, but I don't think that burden specifically falls on them.

It is like if you go to a restaurant. They say the special is a filet mignon encrusted with crab. Do you ask the price before ordering it? Or do you wait and get the bill and then act outraged and say they didn't tell you the price?
RXfiles
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Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am
tibbitts wrote: Thu Sep 17, 2020 11:07 am
RXfiles wrote: Thu Sep 17, 2020 10:24 am Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its all one process. Its not bypassed just bc theyre in the drive thru. Ive run pharmacies with drive thrus for years. The only thing that's different is the patient is in the car. Everything up until that point is exactly the same
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

RXfiles wrote: Thu Sep 17, 2020 11:30 am
michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am
tibbitts wrote: Thu Sep 17, 2020 11:07 am
RXfiles wrote: Thu Sep 17, 2020 10:24 am Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its not bypassed just bc theyre in the drive thru.
I am wrong about what? You seem wrong because that is EXACTLY what the OP says they did asking for payment later in the day. Don't confuse running it through the system and billing the customer. If they did run it before administering it, that isn't particularly relevant. The cost seems to be $160 either way. Did they legally have to tell them that upfront? It is odd they would let them leave without collecting payment. I can see not being able to get it in the car, but they could have gotten a credit card when the appt was made. The OP wasn't clear if they gave their insurance info when making the appointment online, but it sounds like that would be asked in the paperwork.
RXfiles
Posts: 43
Joined: Tue May 26, 2020 1:23 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

michaeljc70 wrote: Thu Sep 17, 2020 11:38 am
RXfiles wrote: Thu Sep 17, 2020 11:30 am
michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am
tibbitts wrote: Thu Sep 17, 2020 11:07 am
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its not bypassed just bc theyre in the drive thru.
I am wrong about what? You seem wrong because that is EXACTLY what the OP says they did asking for payment later in the day. Don't confuse running it through the system and billing the customer. If they did run it before administering it, that isn't particularly relevant. The cost seems to be $160 either way. Did they legally have to tell them that upfront? It is odd they would let them leave without collecting payment. I can see not being able to get it in the car, but they could have gotten a credit card when the appt was made. The OP wasn't clear if they gave their insurance info when making the appointment online, but it sounds like that would be asked in the paperwork.

Idk what we're arguing about here. Either way its still the patients responsible to make sure its covered before receiving the service. It sucks but that's how it is.
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

RXfiles wrote: Thu Sep 17, 2020 11:41 am
michaeljc70 wrote: Thu Sep 17, 2020 11:38 am
RXfiles wrote: Thu Sep 17, 2020 11:30 am
michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am

Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its not bypassed just bc theyre in the drive thru.
I am wrong about what? You seem wrong because that is EXACTLY what the OP says they did asking for payment later in the day. Don't confuse running it through the system and billing the customer. If they did run it before administering it, that isn't particularly relevant. The cost seems to be $160 either way. Did they legally have to tell them that upfront? It is odd they would let them leave without collecting payment. I can see not being able to get it in the car, but they could have gotten a credit card when the appt was made. The OP wasn't clear if they gave their insurance info when making the appointment online, but it sounds like that would be asked in the paperwork.

Idk what we're arguing about here. Either way its still the patients responsible to make sure its covered before receiving the service. It sucks but that's how it is.
We agree on that. I'll add that 90%+ of the time when I don't ask the price on something in advance (whether it is healthcare related or something totally different) it winds up being more than I thought it would be.
marcwd
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Re: Grocery store didn't tell me Shingrix was $160

Post by marcwd »

RXfiles wrote: Thu Sep 17, 2020 11:41 am
michaeljc70 wrote: Thu Sep 17, 2020 11:38 am
RXfiles wrote: Thu Sep 17, 2020 11:30 am
michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am

Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its not bypassed just bc theyre in the drive thru.
I am wrong about what? You seem wrong because that is EXACTLY what the OP says they did asking for payment later in the day. Don't confuse running it through the system and billing the customer. If they did run it before administering it, that isn't particularly relevant. The cost seems to be $160 either way. Did they legally have to tell them that upfront? It is odd they would let them leave without collecting payment. I can see not being able to get it in the car, but they could have gotten a credit card when the appt was made. The OP wasn't clear if they gave their insurance info when making the appointment online, but it sounds like that would be asked in the paperwork.

Idk what we're arguing about here. Either way its still the patients responsible to make sure its covered before receiving the service. It sucks but that's how it is.
Should read:

It’s the patient’s responsibility to know the cost before receiving the service. That’s how it is.
Katietsu
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Re: Grocery store didn't tell me Shingrix was $160

Post by Katietsu »

RXfiles wrote: Thu Sep 17, 2020 11:30 am
michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am
tibbitts wrote: Thu Sep 17, 2020 11:07 am
RXfiles wrote: Thu Sep 17, 2020 10:24 am Pharmacist here.

Its probably that when you get the shot at the VA its billed differently than getting it at a pharmacy. I think most insurances don't cover it till youre 60. I'm years out of retail but that could have changed.

Unfortunately you got the shot its not covered you have to pay. You should have made sure it was covered before you got it. Its the patients responsible to make sure it's covered. Same at a doctor's office.

Call your insurance to make sure its not covered. If its not youre SOL. $160 dollar lesson. Agree on price before you receive any service or good.
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its all one process. Its not bypassed just bc theyre in the drive thru. Ive run pharmacies with drive thrus for years. The only thing that's different is the patient is in the car. Everything up until that point is exactly the same
I have no idea what happened in the OP case. But I am familiar with a “outside” flu shot clinic in my area with plans for more. There is literally a tent in the parking lot with paper printout. Nothing is being “input” at the time of the vaccine.

We have a lot of pharmacies with drive thrus. But most would not be adaptable to giving vaccinations in the regular drive thru. They are all set up like a drive thru bank and laid out such that it would not be safe to administer the vaccination there by a second person. Again, no idea what happened to OP. But with organizations trying to adapt to Covid, I expect a lot more set ups this year that are less ideal than usual.
RXfiles
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Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

Katietsu wrote: Thu Sep 17, 2020 12:02 pm
RXfiles wrote: Thu Sep 17, 2020 11:30 am
michaeljc70 wrote: Thu Sep 17, 2020 11:27 am
RXfiles wrote: Thu Sep 17, 2020 11:12 am
tibbitts wrote: Thu Sep 17, 2020 11:07 am
I agree the OP has to pay, but you can't ask your insurance if a procedure will cost, even if you specify an in-network provider. They will simply say it depends on how the provider codes it. You can ask the provider but the people you have access to at the office don't usually do the billing and won't know all the codes that may result from having the procedure.
Its not a procedure. You can 100% call and ask your insurance if a vaccine is covered at a pharmacy. Its billed the same as any prescription. There is no diagnosis code. You bill for the drug. Prescriptions are billed in real time. A price is determined before the service. Its not like going to the doctor. Theres no way a pharmacy would give a vaccine without trying to bill the patients insurance. Especially an expensive one. Most likely it was just a miscommunication on either OPs end or both parties.
The vaccine was administered in the OP's car. This was not a typical go to the counter, they give you a bag with your prescription, they put it in the computer and say that will be X dollars kind of thing. Ideally, they would have taken the insurance information when they took the appointment and had it run before it was administered.
Youre wrong. This is my job. They dont give vaccines and retroactively bill. I guarantee it. When they input the patients info and screen for contraindications, allergies etc you bill insurance at the same time. Its all one process. Its not bypassed just bc theyre in the drive thru. Ive run pharmacies with drive thrus for years. The only thing that's different is the patient is in the car. Everything up until that point is exactly the same
I have no idea what happened in the OP case. But I am familiar with a “outside” flu shot clinic in my area with plans for more. There is literally a tent in the parking lot with paper printout. Nothing is being “input” at the time of the vaccine.

We have a lot of pharmacies with drive thrus. But most would not be adaptable to giving vaccinations in the regular drive thru. They are all set up like a drive thru bank and laid out such that it would not be safe to administer the vaccination there by a second person. Again, no idea what happened to OP. But with organizations trying to adapt to Covid, I expect a lot more set ups this year that are less ideal than usual.

There is no offsite shingrix shot clinics. This isn't comparable to flu shot clinic.
katrid11
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Re: Grocery store didn't tell me Shingrix was $160

Post by katrid11 »

In some ways some of these comments are just interesting.

Is it the patient's responsibility to understand the cost of a medical procedure before it takes place? Perhaps. I can call my health provider and my insurance provider and ask "How much for a flu shot" and the the "it depends on the code entered" answer. I know if I go to my primary care for just a flu shot, I should be charged $0.

I think OP has a valid point. They made an appointment and IF they provided all the required insurance and personal information, it is the responsibility of the Pharmacy to run the information and get the presumed cost. Not the patients. When the pharmacist administered a shot without a corresponding bill to sign they made a mistake. This happened to my husband who went for a flu shot and walked out with just the "signs of issue" doc. They called 3 days later to say we owed $35. Turns out they never ran the insurance and noted the shot was administered to patient X with no payment made. Running the insurance go them paid. The last time we went to a pharmacy for something other than a medication.

How does OP even know now that the shot should have been covered? Having been to a pharmacy that ran the wrong insurance on a prescription, I can say definitively, you chance to protest a cost comes BEFORE the transaction. IF the Pharmacy didnt inform the patient of the potential costs, how is the Patient at fault?

In the end OP you need to make 2 phone calls. 1 to insurance and find out if it should have been covered and to what extent and 2 to the pharmacy to see if they even ran the insurance.
Gnirk
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Re: Grocery store didn't tell me Shingrix was $160

Post by Gnirk »

To the OP: Did the VA have Shingrix in stock (there is usually a "shortage" of this vaccine). If they didn't have it in stock, then I would apply to them for retroactive coverage and reimbursement. If they did have it in stock, you are probably on the hook for paying for the vaccine you received.

I have Kaiser, and they didn't have the vaccine when I needed it prior to an international trip. They advised me to go to a local grocery store's pharmacy, get and pay for the vaccine and request reimbrusement, which I did. (Medicare wouldn't cover it because I was part of a Medicare Advantae plan). Filled out paperwork, had the pharmacy sign it, and mailed it in with an explanation as to why I had the vacine at that time. Kaiser (Optimum RX) covered it. I had to do the same thing with my flu shot.....Paid for it, and then was reimbursed.

By the way, I asked about the cost BEFORE I had the vaccine.
inbox788
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Re: Grocery store didn't tell me Shingrix was $160

Post by inbox788 »

michaeljc70 wrote: Thu Sep 17, 2020 11:27 amIt is like if you go to a restaurant. They say the special is a filet mignon encrusted with crab. Do you ask the price before ordering it? Or do you wait and get the bill and then act outraged and say they didn't tell you the price?
It depends on whether the cost is in-line with other things they sell and I buy. It's confusing that this was a "Grocery Store", where one might expect to buy $2 apples, not over $100 items. It's probably a pharmacy located inside a grocery store, which should be considered like any other pharmacy. Still, $160 is pretty high even for a pharmacy IMO, but why stop there and not $300 or $3000?

How would you feel at Applebee's, Chili's, or Denny's if you got billed $160 for the special, even if it was encrusted in crab?

Sadly, the lesson here is the old maxim caveat emptor.

Wish medical care wasn't so complicated.

OP, I hope you insurance reimbursement comes through for you.
michaeljc70
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Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

katrid11 wrote: Thu Sep 17, 2020 1:24 pm In some ways some of these comments are just interesting.

Is it the patient's responsibility to understand the cost of a medical procedure before it takes place? Perhaps. I can call my health provider and my insurance provider and ask "How much for a flu shot" and the the "it depends on the code entered" answer. I know if I go to my primary care for just a flu shot, I should be charged $0.

I think OP has a valid point. They made an appointment and IF they provided all the required insurance and personal information, it is the responsibility of the Pharmacy to run the information and get the presumed cost. Not the patients. When the pharmacist administered a shot without a corresponding bill to sign they made a mistake. This happened to my husband who went for a flu shot and walked out with just the "signs of issue" doc. They called 3 days later to say we owed $35. Turns out they never ran the insurance and noted the shot was administered to patient X with no payment made. Running the insurance go them paid. The last time we went to a pharmacy for something other than a medication.

How does OP even know now that the shot should have been covered? Having been to a pharmacy that ran the wrong insurance on a prescription, I can say definitively, you chance to protest a cost comes BEFORE the transaction. IF the Pharmacy didnt inform the patient of the potential costs, how is the Patient at fault?

In the end OP you need to make 2 phone calls. 1 to insurance and find out if it should have been covered and to what extent and 2 to the pharmacy to see if they even ran the insurance.
I bet you the paperwork they filled out online and agreed to for this appointment says that the patient is responsible for all costs not covered by insurance. You will also fill out and sign paperwork saying something similar at just about any new doctor's office.
Last edited by michaeljc70 on Thu Sep 17, 2020 1:56 pm, edited 1 time in total.
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cheese_breath
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Re: Grocery store didn't tell me Shingrix was $160

Post by cheese_breath »

inbox788 wrote: Thu Sep 17, 2020 1:46 pm Still, $160 is pretty high even for a pharmacy IMO...
What would you expect them to charge? The GoodRx card price for Singrix is $155.

https://www.goodrx.com/shingrix
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MathWizard
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Re: Grocery store didn't tell me Shingrix was $160

Post by MathWizard »

DaftInvestor wrote: Wed Sep 16, 2020 4:00 pm
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
Your Dr's Office does them for free?? No Charge to your insurance company?

In my case - the Doctor's Office costs way more than the local drug store or grocery store - getting the local drug store through my insurance can be a bit tougher though.
Free to me. Yes, the ins is charged. I am part of an HMO, and they have decided that preventative care, at least in this case, is cheaper than the alternative. The did the same with shingrix, and whatever the equivalent was before. My primary care physician did have to recommend it.


I actually get flu shots for free from my employer, as can all employees. My employer believes that the increased productivity from my not getting sick, and anyone I might get sick unknowingly, is worth the cost. They probably get the doses at a substantial discount due to a bulk wholesale order.
inbox788
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Re: Grocery store didn't tell me Shingrix was $160

Post by inbox788 »

cheese_breath wrote: Thu Sep 17, 2020 1:56 pm
inbox788 wrote: Thu Sep 17, 2020 1:46 pm Still, $160 is pretty high even for a pharmacy IMO...
What would you expect them to charge? The GoodRx card price for Singrix is $155.

https://www.goodrx.com/shingrix
I'm not talking about the specific charge or amount, just the asymmetry of information. The pharmacy has all the prices, the customer (at least some) have no clue. What's a reasonable or common cost for a vaccination? $0 - $100,000+ isn't helpful or useful. How much for a Tetanus booster? How much for an Ebola vaccination? https://www.fda.gov/news-events/press-a ... lic-health

If the cost of the item is unusual, the seller bears some responsibility IMO. It might not be Singrix or $160, but what if french fries cost $100? Would you like fries with that? Crab encrusted of course.

In this case, OP either wasn't provided any information (bad business practices or employee) or OP missed all the "informed consent", which is possible if not likely. We are bombarded with so much information that we don't or can't process it all. We might never know, but if a lot of people complain (like with robocalls), maybe businesses and others should be doing more to help.
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Last edited by inbox788 on Thu Sep 17, 2020 2:44 pm, edited 1 time in total.
Swimmer
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Re: Grocery store didn't tell me Shingrix was $160

Post by Swimmer »

Big Dog wrote: Wed Sep 16, 2020 1:49 pm
Gill wrote: Wed Sep 16, 2020 1:44 pm $160 after insurance is about the going rate. I paid that for both shots.
Gill
My insurance covered my shingrix shots in full-- no copay, as did my wife's insurance.

+1
MathWizard
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Re: Grocery store didn't tell me Shingrix was $160

Post by MathWizard »

Sconie wrote: Thu Sep 17, 2020 10:34 am
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
Yes, but the concept is the same. The grocery store is selling convenience, and you pay for it.
an_asker
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Re: Grocery store didn't tell me Shingrix was $160

Post by an_asker »

Faith20879 wrote: Thu Sep 17, 2020 9:12 am
LadyIJ wrote: Wed Sep 16, 2020 1:16 pm Just wanted opinions:
... I think they should have told us in the two weeks or even that day, not afterwards.
I can certainly relate. DH just got his first shot a week ago. CVS had his ins. info and said "today's shot is free (covered). ". Now that was before he informed us that there is a 2nd shot involved. When everything was done, he mentioned the booster within 6 months. We just assumed that will be free too. From your experience, we may have assumed wrong.

If when we go back and indeed be asked to pay 160 for the booster shot, I probably will not feel too bad because you have prepared me. If I had not read it here, I would probably feel like you for a few days then pay and move on.
To be honest, if they charge you (or your DH) for the next shot, I think you have more reason to be p*ssed than OP was because, in your case, there was an expectation set that the shot is free (even though they did say "this shot is free").

I am more concerned that you were unaware that Shingrix is a two-shot process (though that is out of scope on this BB).
Northern Flicker
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Re: Grocery store didn't tell me Shingrix was $160

Post by Northern Flicker »

Flu shots are free to the recipient when their insurance covers it, whether administered by a doctor's office or pharmacy. They are never free.
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Big Dog
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Re: Grocery store didn't tell me Shingrix was $160

Post by Big Dog »

TravelGeek wrote: Thu Sep 17, 2020 9:36 am
Faith20879 wrote: Thu Sep 17, 2020 9:12 am
LadyIJ wrote: Wed Sep 16, 2020 1:16 pm Just wanted opinions:
... I think they should have told us in the two weeks or even that day, not afterwards.
I can certainly relate. DH just got his first shot a week ago. CVS had his ins. info and said "today's shot is free (covered). ". Now that was before he informed us that there is a 2nd shot involved. When everything was done, he mentioned the booster within 6 months. We just assumed that will be free too. From your experience, we may have assumed wrong.

If when we go back and indeed be asked to pay 160 for the booster shot, I probably will not feel too bad because you have prepared me. If I had not read it here, I would probably feel like you for a few days then pay and move on.
I think it is highly unlikely that your insurance will pay for the first shot and not the second one.
Exactly. The only issue is: 1) will your insurance plan change by the time the booster is due (six months)? and, 2) will you have met any new deductible for 2021?
Broken Man 1999
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Re: Grocery store didn't tell me Shingrix was $160

Post by Broken Man 1999 »

Big Dog wrote: Thu Sep 17, 2020 3:20 pm
TravelGeek wrote: Thu Sep 17, 2020 9:36 am
Faith20879 wrote: Thu Sep 17, 2020 9:12 am
LadyIJ wrote: Wed Sep 16, 2020 1:16 pm Just wanted opinions:
... I think they should have told us in the two weeks or even that day, not afterwards.
I can certainly relate. DH just got his first shot a week ago. CVS had his ins. info and said "today's shot is free (covered). ". Now that was before he informed us that there is a 2nd shot involved. When everything was done, he mentioned the booster within 6 months. We just assumed that will be free too. From your experience, we may have assumed wrong.

If when we go back and indeed be asked to pay 160 for the booster shot, I probably will not feel too bad because you have prepared me. If I had not read it here, I would probably feel like you for a few days then pay and move on.
I think it is highly unlikely that your insurance will pay for the first shot and not the second one.
Exactly. The only issue is: 1) will your insurance plan change by the time the booster is due (six months)? and, 2) will you have met any new deductible for 2021?
The pharmacist advised me today to return November 16 for my second shot. So, if one has already received their first shot, there is ample time to get the second before the end of the year.

Broken Man 1999
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RXfiles
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Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

MathWizard wrote: Thu Sep 17, 2020 2:43 pm
Sconie wrote: Thu Sep 17, 2020 10:34 am
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
Yes, but the concept is the same. The grocery store is selling convenience, and you pay for it.
The copay is set by your insurance. You pay the same no matter where you get it if its billed to your prescription insurance.
bikechuck
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Re: Grocery store didn't tell me Shingrix was $160

Post by bikechuck »

RXfiles wrote: Thu Sep 17, 2020 5:41 pm
MathWizard wrote: Thu Sep 17, 2020 2:43 pm
Sconie wrote: Thu Sep 17, 2020 10:34 am
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
Yes, but the concept is the same. The grocery store is selling convenience, and you pay for it.
The copay is set by your insurance. You pay the same no matter where you get it if its billed to your prescription insurance.
Not always. My wife had to pay over $300 for her co-pay for just the first shot administered at her doctor's office. She called her part D provider and they told her that her co pay would have been $170 ish if she had the shot at her pharmacy.
GreenLawn
Posts: 82
Joined: Tue Jul 21, 2020 10:58 am

Re: Grocery store didn't tell me Shingrix was $160

Post by GreenLawn »

michaeljc70 wrote: Thu Sep 17, 2020 9:54 am Almost nothing I get done via healthcare do they "tell" me the price upfront. That includes x-rays, CT scans, MRIs, lab tests, prescriptions (they tell me at the register when it is time to pay), etc . Like anything, if you are concerned about the price, ask.

I just got an EOB yesterday from a lab test in February saying it was out of network. Well, I have no control really where my doctor sends this stuff. Most of the lab work was covered but I am guessing this particular test isn't offered by their main lab. Navigating all of it is not easy.
When it comes to medical and dental care I assume that insurance covers nothing until l talk to the insurance company and receive confirmation of coverage for planned procedures and medications. I called up my insurance company to ask about coverage and in-network providers for this season's flu shot.

What a pain to have to micromanage medical expenses this way. It's a hassle but it would have prevented the OP's surprise bill. Consider it a relatively cheap lesson.
michaeljc70
Posts: 7086
Joined: Thu Oct 15, 2015 3:53 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by michaeljc70 »

GreenLawn wrote: Thu Sep 17, 2020 6:46 pm
michaeljc70 wrote: Thu Sep 17, 2020 9:54 am Almost nothing I get done via healthcare do they "tell" me the price upfront. That includes x-rays, CT scans, MRIs, lab tests, prescriptions (they tell me at the register when it is time to pay), etc . Like anything, if you are concerned about the price, ask.

I just got an EOB yesterday from a lab test in February saying it was out of network. Well, I have no control really where my doctor sends this stuff. Most of the lab work was covered but I am guessing this particular test isn't offered by their main lab. Navigating all of it is not easy.
When it comes to medical and dental care I assume that insurance covers nothing until l talk to the insurance company and receive confirmation of coverage for planned procedures and medications. I called up my insurance company to ask about coverage and in-network providers for this season's flu shot.

What a pain to have to micromanage medical expenses this way. It's a hassle but it would have prevented the OP's surprise bill. Consider it a relatively cheap lesson.
It is tricky. The more providers involved, the more complicated it is. In the case of a surgery, way too many moving parts to figure out much in advance. I actually dropped my sample off for the lab. The name on the door was NOT the name of the test provider. It was across from my doctor's office (medical building) and I checked and the name on the door was in network. For $39 I will most likely forget about it (well....see if doctor tries to bill me...and pay if they do). Maybe doctor will eat it. What a system. Frankly, given the climate, you would think all the special interest groups would try to clean things up on their own before regulations they don't want happen.
d18lover
Posts: 22
Joined: Wed Jul 20, 2016 12:31 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by d18lover »

I can't tell you how many doctors forms I sign that tell me anything the insurance doesn't cover will become my full responsibility.

It's just the way it is. They do the best they can, bill insurance, and bill me later. Usually they're correct.
diy60
Posts: 386
Joined: Wed Sep 07, 2016 6:54 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by diy60 »

Broken Man 1999 wrote: Thu Sep 17, 2020 5:08 pmThe pharmacist advised me today to return November 16 for my second shot. So, if one has already received their first shot, there is ample time to get the second before the end of the year.

Broken Man 1999
Correct. The recommended period for the 2nd dose is anytime between 2 to 6 months after receiving the 1st dose. So there is still time to get the 2nd dose if someone has met their annual deductible.
hudson
Posts: 3237
Joined: Fri Apr 06, 2007 9:15 am

Re: Grocery store didn't tell me Shingrix was $160

Post by hudson »

Thanks OP for the useful discussion. I've learned more about how pharmacies work. I would love to know what you find out.
I don't have anything useful to add.
Thanks to all contributors....especially the pharmacist.
RXfiles
Posts: 43
Joined: Tue May 26, 2020 1:23 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by RXfiles »

bikechuck wrote: Thu Sep 17, 2020 6:17 pm
RXfiles wrote: Thu Sep 17, 2020 5:41 pm
MathWizard wrote: Thu Sep 17, 2020 2:43 pm
Sconie wrote: Thu Sep 17, 2020 10:34 am
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
Yes, but the concept is the same. The grocery store is selling convenience, and you pay for it.
The copay is set by your insurance. You pay the same no matter where you get it if its billed to your prescription insurance.
Not always. My wife had to pay over $300 for her co-pay for just the first shot administered at her doctor's office. She called her part D provider and they told her that her co pay would have been $170 ish if she had the shot at her pharmacy.
The doctors office doesnt bill to prescription insurance. They bill medical.
MathWizard
Posts: 4333
Joined: Tue Jul 26, 2011 1:35 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by MathWizard »

RXfiles wrote: Thu Sep 17, 2020 5:41 pm
MathWizard wrote: Thu Sep 17, 2020 2:43 pm
Sconie wrote: Thu Sep 17, 2020 10:34 am
MathWizard wrote: Wed Sep 16, 2020 2:46 pm Flu shots at the grocery store are $35 to $65.

They are free at the Dr's office.

We'll wait a week and get them for free.
My understanding is that Shingrix is different than "regular" flu shots.
Yes, but the concept is the same. The grocery store is selling convenience, and you pay for it.
The copay is set by your insurance. You pay the same no matter where you get it if its billed to your prescription insurance.
The store would not accept insurance, which always decides what it wants to pay.

You may know what your insurance does, but you don't know what my insurance and store does.
tibbitts
Posts: 11885
Joined: Tue Feb 27, 2007 6:50 pm

Re: Grocery store didn't tell me Shingrix was $160

Post by tibbitts »

RXfiles wrote: Thu Sep 17, 2020 7:37 pm
bikechuck wrote: Thu Sep 17, 2020 6:17 pm
RXfiles wrote: Thu Sep 17, 2020 5:41 pm
MathWizard wrote: Thu Sep 17, 2020 2:43 pm
Sconie wrote: Thu Sep 17, 2020 10:34 am

My understanding is that Shingrix is different than "regular" flu shots.
Yes, but the concept is the same. The grocery store is selling convenience, and you pay for it.
The copay is set by your insurance. You pay the same no matter where you get it if its billed to your prescription insurance.
Not always. My wife had to pay over $300 for her co-pay for just the first shot administered at her doctor's office. She called her part D provider and they told her that her co pay would have been $170 ish if she had the shot at her pharmacy.
The doctors office doesn't bill to prescription insurance. They bill medical.
Wouldn't a clinic in a drugstore or other retail store bill similar to a doctor's office for administering a vaccine?
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