Swine Flu Vaccine: Will Insurers Cover the Cost?

Pregnancy has its perks. For one, I never have to worry about getting a seat on the bus. Turns out my swelling belly will also help me score the coveted H1N1 flu vaccine this Fall. According to the Centers for Disease Control and Prevention (CDC), pregnant women and young children top the priority list for receiving immunization against Swine Flu. While I understand why I need the protection -- those "with child" have a tougher time fighting off this strain of influenza -- I wonder if my insurance company plans to pay for it.

I know I should be thrilled there's going to be a vaccine. Along with the rest of America, I got caught up in the hysteria this past spring and often worried that my daughter would catch Swine Flu while at day care. Still, I wasn't jumping for joy when I saw I was at the top of the CDC's priority list. Instead, I started to feel like getting and paying for the vaccine would present a headache I just don't feel like dealing with. I'm already up to my eyeballs in health insurance paperwork related to my pregnancy.

Fortunately, there's some good news on the payment front. Yesterday I spoke with a spokeswoman from America's Health Insurance Plans, which represents health insurance companies, and was told that the government plans to pay for the H1N1 flu vaccine.

Despite the government's plans, this doesn't necessarily mean that getting the vaccine will be entirely free of cost or hassle. While Uncle Sam will pay for the vaccination itself, the doctors can (and probably will) charge for the administration of the shot. Then the insurance companies need to decide if they will cover that cost.

If your physician is in your insurer's network, you'll probably only have to pay a nominal co-fee, say, $20. But if you're like me and see an out-of-network doctor, coverage could get a bit confusing. Will I have to pay for an entire office visit? And if so, will my insurance company think it's medically necessary and cover a portion of the fee? (Answer: every insurer and plan will have different rules.) Or, will I just get charged a smaller fee for popping in for the shot?

At this point, I'd even consider skipping the vaccine just to avoid dealing with the insurance company before the birth. I'm that frustrated with the paperwork. But before I make a decision, I think I'll ask my OB what she plans to charge for the vaccine (or if she even plans to administer it at her office) at my next visit. I know she won't have an answer for me yet since the CDC just released their guidelines a few days ago. But I am hoping my question will at least get my OB thinking about the issue sooner rather than later.

As for my child's vaccine, I imagine I shouldn't have too many problems. Her pediatrician's office is used to giving immunizations and accepts all sorts of insurance plans. My only hassle on this front will be convincing my daughter to sit still for the shot.

Flu Vaccine image by Alvi2047, CC 2.0.