Somebody shoot me [up].

For the last 2.5 weeks, I've been fighting with my insurance company (CareFirst, a real class act) to get a meningitis vaccine for medical school. It turns out that even though all "routine" preventive care is covered in my benefits plan, meningitis vaccinations are decidedly not routine by CareFirst's standards for anyone older than 18 years old. Now, I did get a meningitis vaccination exactly 5 years ago when I was 18. However, Massachusetts law requires that all students attending any post-secondary educational facility with dormitories have the shot within the last 5 years as of matriculation, which is on August 18 this year. So for me, it's injection or rejection. And I refuse to fill out AMCAS yet again.

For all of the policy work that I've been doing with private health insurance, I have realized just how sheltered I have been from the day-to-day struggles with insurers. Basically, the "medical" aspect of my insurance would cover most services rendered by a doctor, including shots and immunizations. However, the doctor is not reimbursed highly for these services, meaning that some procedures may acually result in financial loss for the practice. This was certainly the case with this meningitis shot, which costs $140. If the insurance company provides the doctor $60 for the visit, then s/he would lose $80. For this reason, few doctors would provide the service without charging the patient for the cost of the vaccine. My physician asked me to purchase the vaccine myself from the pharmacy, bring it back to the office, and have a nurse administer the shot. This would have worked, except my pharmacy benefits cover neither injectables nor biologics. Crap.

I was in a bind, despite having good health insurance. Based on my research and experiences, I have the following advice to offer if you find yourself in a similar situation:

• Call your insurance company to make sure that your pharmacy benefits will not cover the cost of the shot. If they do, buy the shot (paying your co-pay or co-insurance) and take it to your doctor to administer. Keep in mind that a lot of vaccines need to be refrigerated.
• If your pharmacy benefits leave you high and dry (or broke and vulnerable to disease...), call the medical benefits department of your insurance plan and ask about the process of prior authorization. The goal here is to find a way to have your medical benefits cover the costs of the shot even if your pharmacy benefits will not.
• Have your doctor put in a request for prior authorization, which will result in the delivery of the drug to his/her office for administration. Your doctor's office will have to make the request, which will also entail their sending a prescription to a distributor.
• If all else fails, try asking your local department of health to see if it has immunization options for underinsured individuals. Washington, D.C., has such a program that provides standard immunizations for free.