My doctor told me my insurance didnt cover gardasil,why wouldn't it , should i contact my provider, i have hmo

Question

My doctor told me my insurance didnt cover gardasil,why wouldn't it , should i contact my provider, i have hmo

Answer 1

Gardasil is considered a preventive medicine or a vaccine/immunization. Some health policies do not cover preventive medicines or vaccines/immunizations over the age of 6. It sounds like you have a policy that will only cover you when are sick, not when you are not sick. Call the member services number on the back of your card and ask if your policy will cover you for preventive medicine or vaccines/immunizations. Another reason you may be denied is the recommended age for Gardasil is between the ages of 9-26 years old. If you are older than that, I don't know of any major carrier that is paying for their members over the age of 26 to receive the shot. Since it's a 2-3 dose protocol, if you turn 26 before the protocol is finished, it would also deny.

Answer 2

Gardasil is a preventative (rather than therapeutic) vaccine. Not all health insurance policies cover preventative health benefits. Another reason might be that not all health insurance policies cover vaccinations.

Even those plans that do cover vaccinations may not reimburse the doctor for the total cost of administering the vaccine. There has been significant opposition from health insurance companies to covering the cost of the vaccine ($360).

Depending upon the State you live in legislation is being proposed to mandate the vaccination for girls entering the sixth grade.

Answer 3

Is Gardasil that new shot to protect against HPV?  There could be several reasons why your insurance doesn't cover it:   1.  it's experimental   2.  it only protects against certain strains, I think 3% or some such and 3.  abstaining from s*x does the same thing, for free.

Answer 4

Many plans today are covering it. Some plans are not covering it for certain age groups (many for patients over 18 don't cover it.) or they're still calling it "experiemental" because it's not a required or mandated vaccine. Because it's not mandated by any law (like the MMR vaccine is in New York state for admission into any public school, for example), it's only "strongly recommended" , they can get away with it.

You should call your insurance company because you need to know *why* specifically, it's not covered. Then, work with your doctor to try to get it covered. I got it covered by an HMO when it first came out because two sisters had a significant family history of cervical and ovarian cancer. If you have a history of such a thing in your family, your doctor can write the insurance a letter asking them to cover it. They may give in.

BUT, all insurance companies have this disclaimer, or some variation of it, "quote of benefits is not a guarantee of payment, actual benefits are determined when a claim is received." So, if the insurance TELLS you they're going to pay for it, they may DO something different, so you need to be prepared for that. Gardisil is a VERY expensive vaccine (it costs the doctors about $150 per dose to buy it.), so if you go ahead with getting the shot, you need to be prepared to pay for it - just in case.

Answer 5

see if there is a generic for gardasil.. it would be much cheaper also call your insurance adn find out what medication they will cover in place of gardasil.. good luck..

Answer 6

Gardasil will only be covered if you are under the age of 26. Now you have not given your age...but this might be the reason.  I word for an insurance company and we cover it.  However it is a three shot process which must be begun before age 26.

Answer 7

Gardasil is now covered under Blue Cross or even a long time ago.If you have HMO maybe its not authorized by your PMG. You dont have preventative benefits or immunization benefits or either you are only allowed to do it once a year . Things like that. IF not still then contact your prescription , maybe it will be covered under your prescription. double check your benefits.

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