Saturday, December 15, 2012

The Search for Pertussis



Several months ago, we were advised by my wife’s doctor that we would both need to receive a pertussis (whooping cough) immunization before our son is born. They gave her one in the office, but because he is not my physician I was unable to procure one for myself. I was told simply to drop by one of their walk-in clinics in order to get one.

I then called the walk-in clinic and they informed me that I would have to see a doctor before they could issue me the immunization which would run me close to $200 since I have a deductible. I argued that I did not need to be seen by a physician since my only malady was a susceptibility to whooping cough which could be cured by an injection.

Unwilling to drop $200 so that a doctor could walk in, shake my hand, and then send in a nurse to give me a shot, I decided to call a few other health emporiums. Each and every one insisted upon medical counsel before they would dispense the goods, an unusual caveat for a service I can get from a pharmacy tech at a Walgreens.

I finally decided to schedule an appointment with the local health department where, for $50 cash money I could receive both immunity and a lollipop. At my wife’s next doctor’s appointment, I was asked if I had received my pertussis shot yet. When I brought him up to speed on my difficulties and swore that I would have my mechanic give me the injection before I dropped $200 on it, he insisted on intervening on my behalf.

He informed me that the clinic itself had a “shot clinic” that dispensed routine immunizations without the cost of an office visit. Elated, my wife and I walked to the counter of the “shot clinic” and I asked the receptionist what the cost would be for a pertussis immunization. The conversation quickly slid into lunacy:

“How much does the pertussis shot cost?”
“Do you have insurance?”
“Yes”
“Then we can go ahead and give you the injection and just bill insurance”
“I have a deductible so the cost will be out-of-pocket anyway and I just wanted see if this way would be cheaper than the health department.”
“Well, we will not know how much the shot costs until we bill insurance.”
“How is that even possible in a capitalistic society? If you have a static cost for the shot and a built-in profit margin you already know the amount of the bill you will send them so just tell that amount to me.”
“We cannot generate the cost until the service has been rendered.”
“Well I am not about to allow you to render a service until I know what it will cost.”
“Perhaps you could call your insurance provider and find out the cost.”
“How could they possibly offer a better perspective on the cost of a rendered service than the entity rendering that service?”
“I am not sure what you need me to do.”
“OK, let’s say I just walked in, don’t have insurance, and wish to simply hand you a pre-determined amount of American currency in exchange for a pertussis immunization. What would that amount be?”
“Sir, are you saying that you no longer have insurance?”


At this point we had involved three employees and the woman behind me looked as if she was contemplating violence if I did not get out of the way, so I just told them to forget it and decided to go to the health department. My plan was foiled; however, when I looked on my insurance provider’s website and they indicated that the shot should be covered 100% as “preventative care.”

Now, a less frugal individual would have simply gone to the health department and moved on with his life, but I decided to call my insurance helpline and go for the win. I spoke to young woman named “Rebecca” who informed me that the shot would be covered as long as it was billed under the name of an in-network physician. When I informed her that the allure of the “shot clinic” was the absence of a physician, she informed me that this was impossible and asked me who requested I get the shot. When I replied the suggestion had come from my wife’s OBGYN she replied that it would be rather difficult to file that claim.

She then called the clinic with me on the line and after ten minutes of bartering the clinic agreed to bill my shot under whatever doctor was listed as “on-call” at the moment the needle entered my arm. I was assured that this would allow me to receive my desired immunization at my desired price. God help me if I ever need surgery…….

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