Posts Tagged ‘is flu vaccine covered on health insurance in Pa’

I Have The Flu! Can My Health Insurance Help Me?

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So you have the flu. You’re in good company since millions of others get it every year. I’m sure that makes you feel better already. But what role does your health insurance have in your treatment and recovery? We take a close look, so you understand the impact of your coverage and how you can use benefits to pay for treatment. But since we aren’t physicians, we can’t guarantee you’ll recover quicker.

Do you even have the flu?

Just because you’re coughing and have had a nagging continuous headache for the last four days, may not mean you have it. Typically, it seems to hit hardest in January and February, and continues for about 7-14 days. Of course, if you can stay home, drink liquids and rest, the duration may be less. But as we know, very few people take two weeks off work for anything,  just short of pneumonia. Unless of course, there’s something good on TV, like perhaps the World Series or a Twilight Zone Marathon.

Get The Vaccine!

Getting the vaccine is highly recommended, although you have to be healthy at the time you get it. If you’re older than six months, studies clearly show it makes sense to be vaccinated. If you work in an environment where there is multiple contact with employees and/or consumers, you’re risk is higher of getting a cold, flu, or another type of infection. Naturally, washing your hands as often as possible at work, and avoiding sick workers helps.

It has been reported that if you get the vaccine, you reduce your chances by 50%-60% of needing treatment for the same condition. Perhaps that is why many insurers are such staunch supporters of their policyholders being treated, because its a win-win situation for everyone. They pay for treatment, and you actually have smaller medical expenses each year.

Fortunately, the deadly MERS virus has not shown up in the state. Originally from Saudi Arabia, the outbreak has been seen in other parts of the US. The symptoms are the same as a standard virus and the fatality rate is very high (30%). Officials here have said that the risk is low. However, recent outbreaks of Measles should be taken more seriously, especially if adults begin to show symptoms.

Pa Flu Season

The Flu Is Not Fun

The vaccine is usually covered under your group or individual health insurance plan in Pennsylvania. Naturally, you may have to check your policy for the specific copay or out of pocket costs. Since most major preventive services are now covered at 100%, there’s a good chance you won’t have to pay anything. Just remember to show your ID card at the time of treatment. However, if you have a “short term” plan or a limited benefit discount policy, it may not be covered.

Nasal Spray Or Shot

Typically, in most parts of the state, you can pick either the spray or shot. However, availability can be a factor and it’s possible the spray may not be available in your area. There is always a risk of side effects although they tend to be mild. Some of the most common ailments are  slight fever, a headache or muscle soreness throughout different parts of the body. Small children should be more closely monitored.

Naturally, stronger than expected reactions, such as uncontrollable coughing, major breathing problems, or sharp pains warrant a visit to a physician, or possibly the emergency room. From an insurance standpoint, all of these conditions (and reactions) are covered on your healthcare plan, although some may be subject to a deductible instead of a small copay. However, non-compliant plans, such as temporary and limited-benefit contracts, may not pay for preventative expenses in their entirety.

Urgent Care visits may be covered with just a copay, while ER visits may have to meet larger copays and possibly a deductible. To view specific differences between companies our Pa Health Insurance Comparison Guide is available online. We also regularly update benefits and rates.

Ease Of Filing The Claim

Both the nasal and needle are handled the same when you file a claim. Although they may be coded differently, the coverage and benefits are equal. If you don’t like needles (like me), for most persons, the size of the needle is about 1/10th the size of a standard needle. The nasal spray, as you might have expected, goes into your nose and is quite painless. It takes about 14 days for the antibodies to start protecting you so, October and November are great months to take care of it.

So do you have the flu? I hope not. But if you’re coughing, sneezing or sweating while reading this, I hope you got your vaccine. And although the light at the end of the tunnel is still a few days away, at least your health insurance will pay most of your bills.