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Cervical Cancer Vaccine: An Incredible Catch-22!

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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:18 AM
Original message
Cervical Cancer Vaccine: An Incredible Catch-22!
My family doctor and I both want to get all my daughters vaccinated. We weren't sure about insurance coverage, so I told him to go ahead and order the vaccine and that I'd pay for it in full if need be. Here's the absolutely incredible Catch-22:

1. The insurance companies cover the vaccine, but they will reimburse the doctor for less than the vaccine costs.

2. The doctor can't really subsidize vaccines for al his patients.

3. Because the vaccine is covered and because the doctor has contracts with the insurance companies; he can't charge me and I can't pay him the difference between what the vaccines cost and what the insurance companies will pay for!

He's going to check to see if I can buy the vaccine directly. Vaccine for two girls will run about $800, but it's a lot cheaper than cancer!
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goddess40 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:22 AM
Response to Original message
1. That's a disgusting amount to charge
They have no conscious, not that I didn't know that already.

I wonder what it costs in other countries? Does your doctor have to pay the difference? That doesn't make sense to me, what your insurance covers should be what the drug company gets.
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LA lady Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:31 AM
Response to Reply #1
7. A little more in UK, should be available the end of the month
The vaccination course consists of three shots and will cost 300 to 360 euros (US$383 to US$460).
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:37 AM
Response to Reply #1
9. Don't even get me started on the flu vaccine screw-up!
One supplier sold and shipped 90% of its vaccine to big box department stores! The others have pulled similar stunts. The result: my doctor, who usually starts handing out flu shots in August (there are a lot of snow birds around here) doesn't have his vaccine and doesn't know when he'll get it. Another brilliant Catch-22: anyone who gets vaccinated after January 1 is considered to have received their flu shot for 2007. If they come back in October 2007 for next season's shot, their insurance company won't cover the "second" shot!

Even better - my doctor doesn't make a profit on flu shots; the big box department stores do!
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LA lady Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:23 AM
Response to Original message
2. A little high
We paid 100$ per dose and it takes 3 injections. Insurance covered it for us. Good luck.
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tanyev Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:25 AM
Response to Original message
3. I think you're supposed to just pray to Jesus that your daughters
don't get cervical cancer.
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lapislzi Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:56 AM
Response to Reply #3
18. The subtext of that is...
don't engage in intercourse. Don't have multiple partners. Don't have premarital sex. Don't have sex in your teens. All these rules for young women, intended to curtail their sexuality. Don't, don't, don't, you dirty girls, or you'll get cancer.
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 09:03 AM
Response to Reply #18
19. As it happens,
my daughters are very unlikely to be exposed. That's not mom with blinders on, that's just the way they are. The point is that you can't predict the future, so it's best to be protected. My grown daughter who is absolutely qualified to wear a white gown at her wedding next summer has already started getting her shots.
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lapislzi Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 12:26 PM
Response to Reply #19
29. You're missing my point
It has nothing to do with the virtue of your daughters which I am sure is beyond reproach. The fact is that HPV is a sexually transmitted disease. Making the vaccine inaccessible to women is another way of remote-controlling women's sexuality. The twisted logic is "if we vaccinate women against this disease we are giving them license to have promiscuous sex--and they will. We can't allow that." They (religious nuts) use the same argument against giving young women access to birth control. It is based on some very, very misogynistic thinking.

Your daughters are lucky indeed that you are doing this for them!
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goddess40 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 09:21 AM
Response to Reply #18
23. and wear a burka because the boys just can't help themselves nt
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Democrat 4 Ever Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:25 AM
Response to Original message
4. And you have to wonder about the women and their daughters,
mothers, aunts, friends, etc. that don't have insurance and can't afford the vaccine. Healthcare in America is only for the affluent. $400.00 is way out of the reach of so many.

Glad you are taking the steps to see you precious daughters protected and glad you have a doctor that understands and is working with you to get this done.
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MannyGoldstein Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:25 AM
Response to Original message
5. Call Your Insurer
Sounds like a fuck up that the insurer will fix if asked. Give them a call and explain the situation - just be nice, but persistant, and make your way up the hierarchy until they take care of it.

According to the CDC, the total cost of the vaccine is about $360 per individual: http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm#hpvv...
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mtnester Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:25 AM
Response to Original message
6. $400.00 each?!?!?!
Someone should be in PRISON for that
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:42 AM
Response to Reply #6
12. That would be $400 for the course of three shots.
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mtnester Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:51 AM
Response to Reply #12
16. I meant for each daughter...I am sticking by my someone should be in
prison statement.

I won't go in to the theory that if the human HPV virus caused men's pizzles to fall off, a much CHEAPER vaccine would be developed in an eye blink. That would be sexist of me.

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LaurenG Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:33 AM
Response to Original message
8. If you wait a month or two that will most likely change
We had the same problem where I work with one of the newer injectables last year. Medicare allowances finally caught up and the other insurance companies followed suit. The discrepancy will probably right itself shortly.
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:44 AM
Response to Reply #8
14. Don't get me started on Medicare allowances!
Because the fee schedule is tilted for heroic measures such as open heart surgery, general practitioners and family doctors who provide the preventive care can not afford to take too many medicare patients. Consider that a doctor may spend 15 to 20 minutes with an elderly patient just to do a healthy patient check-up and you'll see that the fee schedule is out-of-whack.
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LaurenG Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 09:41 AM
Response to Reply #14
25. I know however it's worse than that for specialists. Get This-
Edited on Thu Oct-12-06 09:50 AM by OhioBlues
Medicare is one of our highest payors!


edit: word correction
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Donnachaidh Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:38 AM
Response to Original message
10. how much was the doctor's ACTUAL cost for the vaccine - after markup?
And how much is the PHARMA charging for it?

Too often we get saddled with exhorbitant prices that the doctors *guilt* us into paying. I'd like to see what his actual cost is per unit. I'd also like to know what the Pharma company is charging for it.

$800 for two shots is OBSCENE.
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:41 AM
Response to Reply #10
11. This doctor gave us a room air filter when our son had severe
asthma as a baby. I should also mention that he treats a lot of the migrant workers in the area because he speaks Spanish. I seriously doubt that he is marking up the cost. $800 was his off-the-cost estimate of my costs should I purchase the vaccine from a discounter that he knows of.
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havocmom Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:56 AM
Response to Reply #10
17. Not two shots, course of three shots for 2 people
If I read it correctly, $800 for two young women, three shots per person = six shots at about $134 per shot

But insurers are counting cheap beans and risking women's health for their bottom line. And they are being foolish. A $400 course of shots vs cost of treating cancer. How many women get the cancer? what does THAT cost insurers? They must be saving a buck by discouraging the shots. But they can't be saving a lot of bucks.

Once again, insurance company fucks women.
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RobinA Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 03:51 PM
Response to Reply #17
31. I Don't Think
this is a female issue. Insurance frequently pays less than cost. Of course, "cost" is a relative term, these days. Does it really "cost" $134 to develop and manufacture a shot of this vaccine?
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havocmom Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 07:30 PM
Response to Reply #31
33. Most insurers won't pay for birth control or the doctors visits to get RX
Many women have lost battle to get them to pay when pills are prescribed for medical reasons unrelated to preventing pregnancy. Women have had less than great care from insurance companies for DECADES

Harder for some screening tests women need to be paid for by many insurers too. Many insurers getting stingy about mammograms and even pap smears of late.

But those little blue pills for the gents... usually covered.
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photogirl12 Donating Member (887 posts) Send PM | Profile | Ignore Thu Oct-12-06 08:42 AM
Response to Original message
13. I really think it is horrible
that the insurance companies can do that. There really needs to be insurance reform in the United States. If the insurance doesn't totally cover it, then what exactly are we paying the insurance companies for???
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newyawker99 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 03:39 PM
Response to Reply #13
30. Hi photogirl12!!
Welcome to DU!! :toast:
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acmejack Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 08:50 AM
Response to Original message
15. Insurance companies are thieves.
They take your money and then look for anyway possible to deny you coverage when you need it. I lost everything when I got sick, despite having letters from my doctors having a pacemaker implanted, being rushed to the emergency room and almost dying twice. Faking, you tell me. Had to sue to get reimbursed.

They delayed and ran up the legal tab, if I wouldn't have had a lawyer in the family who was able to pro bono me and lend me over 20K to stay alive on for the over 2 years they drug it out after I had descended into poverty (I was too proud to ask for help). I would have killed myself (literally). They are thugs & I despise them..
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 09:05 AM
Response to Reply #15
20. Isn't it amazing how the clerk at the insurance company is somehow more
qualified to diagnose your symptoms and determine a course of treatment than the doctor who only went to through 8 or 12 years of training?
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photogirl12 Donating Member (887 posts) Send PM | Profile | Ignore Thu Oct-12-06 11:07 AM
Response to Reply #20
26. That reminds me
of the time I had to have oral surgery and the insurance company told me that I would have to go to a general surgeon instead of an oral surgeon because they didn't cover it. Really, insurance companies drive me nuts.
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Democrat 4 Ever Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 09:12 AM
Response to Reply #15
21. Kinda off the subject but did anyone see Boston Legal the other
night? The story line was where a HMO had shipped a woman with heart disease to India for surgery because it was $10,000 over there compared to $90,000 here in the states. She died in a foreign country alone because they husband couldn't afford to travel with her.

Now I know this is a fiction TV show but Boston Legal often hit on real issues (had an excellent story line on the homeless) in the course of entertaining us. They may it sound like this is really happening. Does anyone know if HMOs are shuttling people to other countries for procedures?

Inquiring mind wants to know if there is a kernel of truth in all of this.

I hate the organized crime of health insurance companies. They kill ten times more people a year than any mafia group did in decades of dirty work.
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tanyev Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 09:16 AM
Response to Reply #21
22. I've read several articles about people who opt to go to
foreign countries for surgeries and pay out of their own pocket. I seem to recall reading that insurance companies were considering doing this but I haven't heard of it actually happening yet. Boston Legal is probably ahead of the curve on raising the issue.
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Pugee Donating Member (295 posts) Send PM | Profile | Ignore Thu Oct-12-06 09:29 AM
Response to Reply #21
24. It is happening here. If this happened once, surely there are others
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Quantess Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 11:28 AM
Response to Original message
27. It's a lousy situation, I fully agree.
But, since no one else has mentioned it, I would like to comment on the ovewhelmingly reasonable response from the masses, concerning the vaccine.

Remember at the very beginning when the news first broke? Mainstream newspapers everywhere pandered to the religious right by saying that vaccinating girls would be morally questionable because it might encourage promiscuity. Even The Oregonian, which was my local paper at the time, said so. You had better believe I wrote a LTTE! I informed them of my disgust at their attempt to attach "morals" to the issue, and I'm sure I wasn't the only one! Women have reacted to this issue overwhelmingly as a health concern. The "moral" aspect is not nearly as salient to women, nor to parents, as right-wingers had predicted.

The voices of common sense and good judgment coming from average American women, and parents, is very heartening to me. It gives me hope that the people of the USA are not as backwards and screwed-up as the fundie lobbyists would have us believe.
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hedgehog Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-12-06 12:16 PM
Response to Reply #27
28. My parents and I are Irish Catholic, and my 78 year old mother
wants these girls to get vaccinated. As she says, how are these girls to know their husbands' histories or future behavior?

Promiscuity? Given todays' songs, movies, television shows, videos, advertisements, social mores etc; girls are going to go wild because they get a shot? Please!
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boolean Donating Member (992 posts) Send PM | Profile | Ignore Thu Oct-12-06 03:55 PM
Response to Original message
32. You're a bad parent
Maybe you should try giving your girls some values so they don't have premarital sex.

:sarcasm: :sarcasm: :sarcasm: :sarcasm: :sarcasm: :sarcasm: :sarcasm:
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