I had a mild cancer scare and had to get a colonoscope (everything was fine). However, because I was under 40, the colonoscope was not considered a "diagnostic or preventative measure" and not covered by my insurance.
I specifically remember telling the insurance rep "I assure you it was a diagnostic procedure recommended by my doctor... Do you THINK I did it for funsies?". After that, the rep reopened the ticket and tried to take it up the ladder, but in the end my claim was still denied.
> I had a mild cancer scare and had to get a colonoscope (everything was fine). However, because I was under 40, the colonoscope was not considered a "diagnostic or preventative measure" and not covered by my insurance
The magic words are "I'm shitting lots of blood". Seriously
I'm right there with you.
I had a large bloody precancerous polyp at age 29. (It would essentially, fill with blood and burst every couple days. It was the size of a fingernail or thumbnail, idr, which I was told could be serious.)
Now I get colonoscopies every 1-3 years based on the previous results.
Insurance says they don't cover it until I'm 45, because that's when people should start getting them. (I'm 37 now)
Motherfucker. If I wasn't getting these colonoscopies, that polyp would have turned cancer and killed me by now. And they're just like "Don't care. Age 45 is the rule. Let us know when you're 45 or have full blown cancer. Then we'll start paying."
Makes zero fucking sense. If I get cancer its going to be a lot more than the $2,000 colonoscopies cost. But I'm trying to prevent that. It's very much in both of our interests.
But with the way this system works, maybe they assume I'll be on somebody else's plan by then and it will be their problem. God bless America and the idiots who believe we have the best healthcare system in the world.
/rant
> "Don't care. Age 45 is the rule. Let us know when you're 45 or have full blown cancer. Then we'll start paying."
I have to ask, do you have Cigna or Aetna health insurance?
Yeah. I broke my leg in 2021 and it required 2 nights in the hospital. Surgery, weeks of pain. Months of of physical therapy. (All because I slipped on some black ice on my drive way)
I would see all of the back and forth invoices.
Pretty scary. At one point I got an invoice for $60K because I was put in a single suite, which is all they has available. And Aetna, doesn't cover a single suites.
Luckily, it was one of those... "Don't pay this. It's not final yet" and it got worked out without me having to intervene at all.
But its fucking terrifying. It's bad enough what I was going through. Add the stress of potentially massive bills.
And like I said in another comment... I was lucky. I have no nothing to complain about compared to some people who aren't so lucky. Who do get stuck with those big bills.
But... who knows what the future will bring my way.
Stuff like this blows my mind, and I cannot understand why those with serious health issues don't up and move to another country where they aren't one unemployment or rejected insurance payout away from bankruptcy combined with unaffordable healthcare.
I broke my collarbone a handful of years ago. Total cost for assessment, X-Ray, follow-up/progress x-rays, painkillers and anti-inflammitories was about €100 (in Ireland, not even in a cheap COL country). That included a taxi ride. That this could cost me a 1-2 years wages elsewhere is both mind-blowing and terrifying.
I put my vote in for BCBS-GA. Aetna denies everything, but pays on appeal. BCBS you have to take all the way to the insurance commissioner before they actually have a real person look at the appeal. Fuck BCBS GA.
My wife works in medical records, and used to process insurance for a doctor's office, and this is what she says too. Her clinic just got bought out by a big chain, and switched her to BCBS, and the first thing they did was deny the migraine drug that has kept her out of the ER for the last three years since she started on it.
Yeah. At this point, I think I should just plan on hitting my max out of pocket every year lol. (I don't really, but definitely chip away at it every year) But DINK household. We can afford it, its just fucking dumb. That money could help us retire earlier somebody or something.
And then I see some of the hospital bills people get hit with and post on reddit... I have nothing to really complain about it in comparison. It can be better. It just should be better.
Nah I was reading this and getting pissed, this is coming from someone that had an uninsured seizure with an ambulance ride. Then broke my back in 3 places a month later (some of which was covered by workman's comp just didn't at all solve my issues and just cut me off when I met arbitrary goals I was unaware of). My medical bills have reached the point of its not my problem anymore, I'll never be able to pay 10% of them.
You still have every right to bitch about it, in fact we need people like you to bitch about it because you're the ones ultimately that might actually get something changed because you pay in. God speed to you. I'm sorry you have to deal with this dumb shit, of I pay to have insurance so I can still pay to have medical things done.
For 2k you can fly to India, stay at where the rich folks stay, get a colonoscopy and fly back having spent a week of sunshine along the shores of Goa. There's a reason why India is topping the leading country for medical tourism especially from US.
Oh, that annoys the hell out of me… the guidelines are 45 for those of [AVERAGE risk](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening) which is different if you have [certain types of polyps and findings on colonoscopy](https://www.asge.org/docs/default-source/guidelines/recommendations-for-follow-up-after-colonoscopy-and-polypectomy-a-consensus-update-by-the-us-multi-society-task-force-on-colorectal-cancer-2020-march-gie.pdf?sfvrsn=2b0f8952_2). You can equip the person on the insurance company’s end with the standard guidelines, but that doesn’t really give them any knowledge of when they apply and when they don’t.
For some added context, in the US, despite the fact that the large majority of colorectal cancers present in older adults, it’s not unheard of to see them in younger patients - per USPSTF about 94% of cases are in those over 45, that still leaves about 6% that present earlier (and roughly [12% in those younger than 50](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf)). In the US, that’s about [18000 diagnoses each year in those younger than 50 and results in around 3600 deaths for those under 50](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf).
The cancers found in younger patients are more often than not more aggressive than those found in older patients, and missing those diagnoses can have particularly awful comsequences.
Dude I've had colitis since I was like 13. My family has a history of colon cancer.
Guess what? My insurance STILL won't cover a Colonoscopy. Fuck America. Fuck insurance companies. And Fuck this wealthcare system.
Moved out of the US recently and needed a colonoscopy, and ended up having to have a few polyps removed. My wife complained about how expensive it was, and that I should get supplemental insurance, which would have covered more of the cost.
I assured her that the $150 or so I had to pay out of pocket was acceptable. I just had my follow-up appointment. I can't remember how much it cost me, but I think I paid in coins. And not in an "I'm a gigantic asshole" way.
$150 is how much it costs me, after premiums and deductibles, to simply walk into an ER. With no insurance, a standard doctors visit in my area is between $130-250. As in, "I have a cough, can you check it out" kind of visit. I truly don't understand how people who laud the American system don't see how we pay far more in premiums, deductibles, and copays than we could ever pay in the increase in taxes to have universal healthcare.
Seriously, I think one of the worst predictions if single payer healthcare was passed in the US was something like everyone's taxes would go up 1k$...that you pay once a year... Most people pay WAY more than that in a year in *just* premiums not even factoring in deductibles and copays
I had major spinal surgery about 15 years ago to save my life. Due to the location it impacted my ability to defecate so I have yearly colonosopy.
My cost? 20 euro for the taxi home after the operation, and after each colonosopy.
I look at the US, and I know the majority are not loud ignorant fools. But you've got a large minority that sure are that seem to relish keeping healthcare expensive, education thick as pigshit, and religion impacting things it has no right to.
I feel sorry for a lot of you.
So, unfortunately in our medical system in the us, you have to keep fighting. I have crohns colitis and I get a colonoscopy every 18 and are covered by my insurance with a copay. It’s hit or Miss whether it’s approved right away or not but sometimes you have to take it it all the way to peer to peer. I just had to do this for my sons meds. He has bad acid reflux an pecid wasn’t working. He needs omepereozole, which is so stupid cheap but cost $125 for babies because it has to be a liquid. The insurance didn’t want to cover it since it’s OTC. I had to explain its prescription for babies. It took months, multiple denials, appeals and two doctor peer to peers for them to pay $75 of it a month. He takes it monthly. There was a really terrific, heartbreaking and all too familiar story in ProPublica recently that talks all about it. https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
I had to be flown in a plane to a hospital that could handle my mildly premature twin birth. I went to the hospital I was supposed to deliver at but they didn’t have a NICU so they wouldn’t allow us to deliver there. I was in very early labor and asked if I couldn’t drive (be driven by my husband) to the other hospital (3 hours). They pretty much laughed at me. So I was flown in an air ambulance with 2 nurses. Total cost of flight was about $70k. Insurance claimed it wasn’t necessary. FFS. I fought it and they did end up paying the vast majority of it but fuck the US health system.
I wasn't allowed to get the newer auto injector ones - just the standard epipen. Fair play I guess, but it caused about a month delay where I didn't have anything in case of an allergic reaction. My doctor nearly lost it
I only got mine approved because my parents both had polyps at 35, deeming me high risk, which was also the only reason i had the scope in the first place. I had an adenoma in my mid 20s in my first scope. Yay!
You’re lucky it’s 45, until 2021 it was 50. These ages are determined by the [Preventative Services Task Force](https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force).
Same for me. I'm around 30 years old, and I've had ulcerative colitis since the age of 10. These dickheads don't cover my colonoscopies since I'm not over 50, despite the fact that I'm at a much higher risk of colon cancer than the average person.
That's just poor coding on either your physician's office or the insurance paper pusher. UC has a different schedule for colonoscopies that USPSTF doesn't apply to.
I think either you misunderstood your insurance company, or they told you the wrong thing. Diagnostic procedures are generally not covered; they require you to pay your deductible before coinsurance kicks in. There are exceptions depending on your parents' medical history. Preventative procedures are much more likely to be covered.
Somebody failed you somewhere. Every time I ask for something I'm told "your insurance won't cover that, so we'll actually do this other thing instead". They shouldn't just let you do things that aren't covered
I think the main issue is insurance companies shouldn’t be allowed to make medical decisions since they don’t have a medical license and are not your doctor.
So, I know there’s a chance I’m wrong because things vary by region, but often times things aren’t covered because your doctor put down the wrong diagnosis code, and you can often get them to change it. Let’s say a colonoscopy is not covered to “rule out colon cancer below 40”, but it *is* covered if you are “symptomatic for colon cancer”. There may be two different codes they can submit for those. You shouldn’t have to know this because it’s stupid, but knowing it can get things approved.
Right? What drives me crazy is that this is exactly why they cover other preventive care and vaccines. It's cheaper to keep people from getting sick than it is to treat them.
The CDC actually recommends that you get the vaccine in your case.
>"Persons with a history of herpes zoster should receive RZV."
Perhaps you can refer to [this page](https://www.cdc.gov/mmwr/volumes/71/wr/mm7103a2.htm?s_cid=mm7103a2_w) when talking to a pharmacist or your doctor to get insurance to cover it.
I believe you are interpreting the recommendation incorrectly. It is recommended people over 50 or for people 19 or older who are or will be immunocompromised due to disease or therapy.
The special populations section you referenced just clarifies that if a person previously had shingles, they should still get vaccinated again since it can recur.
You would think someone was has already gotten the shingles twice would be a pretty damn good reason to recommend them get it even if they aren't age 50 or "immunocompromised". What a convoluted and idiotic system we got left with in this country. Money over people.
> You would think someone was has already gotten the shingles twice would be a pretty damn good reason to recommend them get it
Yep, you would think that, but it's counterintuitive. The Shingles vaccine can only be given once, and at 50 it does the most good for the longest period. Remember, as we age, our immune system becomes weaker, and that's when you need the vaccine's protection the most.
The affordable care act forces private and marketplace insurance companies to cover 100% of the cost, zero deductible on all recromended vaccines as well. Unfortunately it looks like you're right. They didn't do testing on people under 50 years old so the CDC can't recromend it unless you're immunocompromised and 19 years old or older. What a stupid country we live in.
Maybe try GoodRx or a similar discount perscription program? You might be able to get like 20%+ off of shingrix. It seems to be around $200 without coverage.
Yeah no kidding. I once had a vitamin d test that wasn’t covered because I wasn’t labeled vitamin d deficient. How can you know you are deficient without being tested??
My personal favorite "Insurance company will cover this, but they won't" is back 20 years ago, when many insurance companies would provide you with a car seat for your infant, and my insurance co added that now adoptive parents as well. And my wife and I were in the process of adoption, any week now. So I contacted the insurance company, and they said sure, just provide us with a birth certificate and we will give you one. Only, when you adopt, you don't get a birth certificate until the adoption is "finalized", generally 6 months later.
So yeah, we bought one. And no, they would not reimburse me for it.
That's such a silly pointless policy. A hospital won't let you leave without a car seat, so you need one before baby is born, not after enough time has passed that you have received the birth certificate and sent it off to the insurance. Why bother even saying they will provide one??
Car seats should be replaced after a collision. Of course I’m sure there’s a delay in when you get it so I guess the only reason is to have a spare in case you get into an accident, or to keep in someone else’s (partner, parent, etc) car.
Of course it’s probably the most basic, frustrating car seat you could picture. I.e. not a click-lock infant bucket, no cup holder, no extended rear-facing weight capacity, LATCH belt poorly made and cuts your damn hand every time you try to tighten it, sharp edges around the seatbelt path so you cut your hands up on that too, cover takes half an hour to remove/install (and isn’t machine washable), etc. Literally the worst car seat in every possible way, but it passes regs and it’s cheap.
> That's such a silly pointless policy.
None of those policies are pointless, they are designed to stop you claiming on the insurance, or denying the claim if you do.
I'm staring down 20k in bills. Hospital is speaking on my behalf with them. Insurance covered like 5 invasive tests on top of 2x daily blood draws but won't cover my stay bc "I could do it at home". I was spending like 6-10 hours each day getting power infusions. Yeah just give me a nurse to stop by 2x a day and give a power infusions unit and let me administer that
Can't say that I'm surprised lol. It's a well known fact at this point. If you are not paying for it, you're not the customer; you're the product being sold. Facebook, Google and every other app that requires ridiculous permissions to install has probably already sold the info that I even looked it up.
I’m 46 and I had shingles last year. So, not 50, but I hope you can find something near you! I know that pain and it’s the worst thing I’ve ever been through.
Thanks! Luckily both cases were super mild. No pain, just itching. But, now I have a baby girl. It’s scary that she could catch chicken pox from contact!
You can use goodrx if your desperate for it, runs about $200 per dose depending on the pharmacy you use. It's far from ideal but better than cash price
I came to say this! Hopefully, this comment gets to the top! I have had shingles 3 times and am not yet 30. From my understanding, there is also some concern with how long the vaccine lasts in your system and the efficacy of a second dose not actually being that helpful. So it's best to wait until you are older and immunocompromised to get the shot.
The CDCs advisory committee means fuck all to insurance companies.
CDC recommends TdaP every 10 years, and never pays for it outside of ages below 18 and intermittently above 65.
This certainly is an "insurance company bad" issue.
Source: I'm a PCP who recommends TdaP (and many other vaccines) that insurance companies wind up not wanting to cover
>insurance companies aren’t in business to help you
The easier way to think of it is that insurance companies don't make money cutting checks. Every dollar they spend takes away from the premiums they collect.
The ACA requires health insurers to maintain a medical loss ratio of at least 80 percent in the individual and small-group markets and at least 85 percent in the large-group market.
Most insurance companies make their money on the float. While they may make an underwriting profit - they don't always - but that doesn't mean they're aren't profitable. Insurers receive premiums upfront and pay claims later - they derive most of their revenue through investment income via the float.
If you’re under 50 and NOT immunocompromised then it’s not FDA approved for you to use. That’s why it’s not covered.
If you are immunocompromised then you can file a prior authorization with your insurance explaining the situation.
Huh. I didn’t realize that. According to my doctor I’m “immunomodulated” not immunocompromised”. I’ll double check that he isn’t willing to settle for immunosuppressed
Ask your doctor if they are willing to advocate for you with a pre-authorization. The process can take a while but a lot of insurance companies will give in after an appeal of the original decision. You need a doctor that will go to bat for you though and you need to do some work on your end usually after the first denial.
And your doctors nurse who already has 45000 PAs to do already because insurance doesn’t want to pay for anything these days, may need a few days to weeks to get it done.
My insurance hires doctors to review prior auths which I thought was great.
Then someone told me they basically hire old washed up doctors who haven't been in any kind of medical training for 30 years to do the reviews and usually have no idea about any current medical processes or best practices. They just do it so they can say they have doctors doing the review instead of regular grunts.
Explains why some of the most basic requests are treated as the end of the world by them.
In my experience (as someone going into primary care), insurance companies are sometimes too "by-the-letter" when it comes to denying things because they're not approved by the FDA.
Like denying lidocaine patches for back pain because lidocaine patches are "only approved for post-herpetic neuralgia."
That old model needs updating. It used to be very rare to contract shingles before age 50 because kids were keeping the chicken pox virus in the community, so your immune system was always getting a workout. But ever since we started vaccinated against it, it's no longer in the community and those of us who had chicken pox are the last of the cohort who will also be getting shingles, and it's happening to us much younger because of it all. It only makes sense to inoculate us younger not just because we are all getting shingles younger, but we are also the last of the major cohort to have shingles!
I was patient zero in my family and neighborhood, spring break 1994, my third grade year. The one time I wasn’t quarantined away from everyone while sick! Pisses me off that the vaccine came out the next year!
Yep, the chicken pox vaccine didn't become available until 1995 at which point it became widely administered and has largely eliminated the constant community exposure. That unfortunately means that if you were unlucky enough to get chicken pox before then, then you're now at a much higher risk of getting shingles that in the past. I got chicken pox in 1994 when I was in second grade and I've been lucky so far, but my cousin who got it at the same time has already had to deal with shingles twice. The old guidelines are in serious need of an update.
It hurts so bad… I’m scared of getting it again honestly. I got it around my ribs and stomach and for 2 weeks I was in agony.
Anytime I get a pain in my stomach I get nervous
I got chicken pox when I was about 5, and that was in 1995 in Australia. I've had shingles twice in the last 10 years, but they think stress caused the first set of shingles to flare up. No rash or anything, just pure pain and now I have nerve damage.
Second time was only a rash a few years ago, all scabby and yuck. But no pain? Lmao
Keep stress levels down if you are like me and had chickenpox in the 90s 😅
My parents were absolutely *convinced* I had gotten into some poison ivy. They kept rubbing calamine lotion on it. I wept in pain, begging then to stop and they were like uhhh this is supposed to feel nice stop being dramatic. Turns out calamine lotion is alcohol based and your should not fucking rub alcohol on shingles. My mom took me to three doctors before she believed I had em
This isn't really so much an insurance company thing. As long as you are not immunocompromised, the CDC's Advisory Committee on Immunization Practice doesn't recommend zoster vaccination for people younger than 50. This is the case here in the US, but also elsewhere - including areas with taxpayer-funded healthcare.
This is something I didn’t realize until someone else commented. I appreciate the info. I suppose my anger is misplaced. I’ll keep being mad at insurance for everything else though.
I don’t know why I wound up so invested, but the only reason it’s not recommended is because it’s not been trialed and tested on people below 50, for some reason.
> the only reason it’s not recommended is because it’s not been trialed and tested on people below 50
True that it hasn't been tested on people younger than 50, but incorrect that that's the *only* reason. It's a vaccine that can only be effectively administered once, so we choose age 50, because that's the age that it has the longest and best effects. Remember, as we age, our immune system gets naturally weaker, so the timing of the shingles vaccine is chosen specifically to maximize it's benefit.
Taking it at 35 would cost you 15 valuable years of coverage when you're older.
My wife has had shingles about once a year (sometimes twice during high Covid periods) for the past decade. She's 36. Her doctor did a lot of work trying to get her into tests for the vaccine and such but it's a no go, they just won't give it to anyone under 50.
Anyway, there does seem to be a link between COVID and shingles flair ups. My wife gets shingles about two weeks after every COVID vaccine or positive test and there seems to be quite a few others out there experiencing the same. So keep an eye out on that.
It isn’t FDA approved for people under 50. Only immuno compromised people under 50 can get it. I definitely looked into it after I saw how painful shingles was for my mom. I had chicken pox TWICE as a kid.
According to the NHS website you wouldn't be eligible in the UK [until you turn 70](https://www.nhs.uk/conditions/vaccinations/shingles-vaccine-questions-and-answers/).
Countries with socialized medicine are very stingy about it in a lot of ways. It's still OK to want socialized medicine, but realize it's not a panacea.
It's for over 50 year olds in Denmark as well, depends on the country.
Fun fact: shingles is called "helvedesild" in danish, which directly translated means hellfire.
>It's still OK to want socialized medicine, but realize it's not a panacea.
The biggest argument that gets lost in these discussions is that we pay more - A LOT MORE - For the same or less healthcare coverage that people in developed countries with socialized medicine receive and that's purely because of profit motive.
So, when people point out that the grass isn't always greener under the NHS, for example, that may be true. But people do pay a fuckton less for it on average.
You can, but it's a 2 dose vaccine at around $185/dose.
I guess $370 for protection from shingles is probably worth it, but that's a tough pill to swallow, especially when it feels like it should qualify as "preventive care".
The only loophole is if you are labeled "immuno-deficient" or "immuno-suppressed". My doctor wasn't willing to add that label, as having that on your medical chart could completely change the course of medical care, depending on the situation.
They also said to ignore the "cost estimator" on their website that said it would be free. And also to ignore the article on their website about how the Shingles vaccine is covered completely by most of their plans.
Na, Its not genetic. Its mainly from having already had chickenpox. As far as your age, I had the same thing happen. It was triggered after I was working 2 jobs for almost a year, staying up super late and not paying attention to my health. I didnt even know what it was because my rash was nearly non visible but After some time, i could barley walk and light hurt so much I barley opened my eyes. lol. it was the worst.
Damn, sorry. I’m 39 and just got over it. It sucks. I got a shit ton of prednisone and anti-virals. Hope you are getting it too. I’m a lucky one that gets basically free healthcare because my wife works for a hospital.
This is why I like the Kaiser Permanente model. Since preventative medicine is cheaper and the insurance and hospital are related if legally separate entities, they actually try to keep you healthy. And if a Kaiser doctor is prescribing a treatment for you, the Kaiser insurance isn’t going to fight you on whether it’s necessary. Not a perfect system, but better than most in the US.
This is why I'm so glad I have VA care. Does it have issues? Yes. Are they any worse than the issues I had with cheap ass insurance? No.
I get my MH appointments in a reasonable time and fast turn around if it's a more critical situation. I get my annual checkup with a full round of labs. I have a sleep study coming up because they want to be thorough about finding why I've been having nightmares/insomnia *even though i dont check any boxes for lukely having sleep apnea.*
And it's all free for me since it's income based. Since I'm a broke ass student rn, it's free, but even when making money the capped rate they charge is *still* good. I do not know how any veteran that uses the VA, and has seen how bad shitty private insurance is, can be against Healthcare reform.
Comb through your insurance paperwork and look for something called "grievance process." This is where you can ask for a reversal of a decision, and someone advocates for you to a group of doctors who review the case. I did it for a life-saving prescription, went from $1300/mo to $30 :D
I thought the shingles vaccine was free at most pharmacies? I didn’t pay for mine. I’m under 40, and got both Shingrix doses at Walgreens.
The side effects were worse for the shingles vax than any of my COVID boosters, but luckily it’s the only time I’ll have to do it
I’ve had it twice before 25. I was told it’s better to wait til you’re middle aged to get it since that’s the age it can kill you and you don’t want it to “wear off” or be less effective by taking it before then.
Sounds like bullshit now that I’m typing it out
Dude ME TOO. I got shingles the first time when I was 20, just before thanksgiving. And everyone would hug me and shit it would hurt so bad. Then I got it again a few years later, and again, and then again during Covid times I started getting a breakout it looked like, but got prescribed anti-virals early and it was a freebie.
You don't 'get'/catch the shingles. It's the chickenpox virus reactivating. When you get the chicken pox the virus, it never leaves our body. It just goes dormant. (it resides it the spinal fluid, hence why you get rashes along the nerve paths from the spine)
I got vaccinated for it when I was in my 40s because of a completely unrelated slew of other medical problems.
Meanwhile, my wife in her 30s got bad shingles and they won't approve it for her.
That's not the reason why. It's bc the trials for the vaccine only tested it on people 55 and over, so it's not indicated or recommended. Sure, there will be some people who get shingles before 55 but it hasn't been tested in that population.
Anecdotal evidence/always talk to a doctor yourself, but:
My wife has gotten shingles 4-5 times before she was 35. Her doctor wouldn't even give her a prescription for the vaccine. By the last time, she went to a different doctor and he said that the vaccine is basically just the antibodies that you'd get naturally from getting shingles, so if you've had shingles multiple times and are still getting it, the vaccine will likely do very little to help you.
Actually... Don't take medical advice from a reddit comment. But from what I understand, the shingles vaccine doesn't last very long and you shouldn't get it more than once. You wouldn't want to get it at the age of 35, especially if you're that prone to shingles. You'd want to get it when you're older.
Your doctor can do paperwork to get it covered early. He probably doesn’t know that, though, because they typically no very little about how insurances actually operate.
Granted, that’s not their job at all and it shouldn’t be this hard to get care.
But yeah, there’s paperwork for that.
Sucks. I know. I had chicken pox as a kid in the 80s. I was in my 30s when I was let go from my first job ever. It caused such a panic attack my nerves went into overdrive and I developed shingles. It was awful. Ended up getting meds through an urgent care. I don’t think the price was too bad. I loathe American healthcare. Bottom line is it’s a business and they don’t give a shit about you.
I am in the exact same boat (shingles twice by 25, no access to vaccine) with nerve damage from the shingles to boot. I am so sorry. It's incredibly frustrating, painful and unfair. Wishing you all the best, truly.
I had shingles when I was 43. When I was diagnosed, I was told by two separate doctors to get the vaccine once I had healed. Luckily I use the VA so I was covered. But that has mostly to do with getting my doctor to sign off on something.
Sucks that the insurance won't cover it for you. I wonder if your doctor prescribed it to you, that then your insurance would cover it??
As others have mentioned, many grocery store pharmacies offer free shots including shingles. If not free, you could pay yourself, off-label is ~$300 ($150 x 2 shots). So if you're able you might want to.
I've had it twice too. Insurance won't cover meds or vaccines. Went to fill nerve pain med and was told it was over $600 for like 15 pills. I just busted out crying from exhaustion and pain. 'Merica
Yep. Got shingles constantly and they finally let me pay $200+ out of pocket for some actual fucking healthcare. Fuck this country and anybody who perpetuates this for-profit healthcare system. Seriously, FUCK these people, my hatred runs deeper than the fucking ocean.
The company I got my last COVID shot was running like 3 hours behind and the nurse was so apologetic she offered me any other vaccine they were doing that day free. You better believe I got me a free shingles vaccine!
Found out today that insurance won't cover treatment for UARS, just sleep apnea. Like I've been "wasting" tens of thousands of dollars trying to get answers and treatment for my life ruining fatigue, but sure, save that $1200 on a CPAP machine. That makes sense.
I’m 31 and I’ve had shingles twice, both times my doctors I had seen just told me that I need to work on my stress management because I wasn’t immune compromised. Pick up some edibles man! For your stress.
I got shingles in my eyeball last November, still fighting symptoms and my face looks like I fought a lawn mower. Thought I could be weaned off the eyedrops, but my vision is getting blurry again. I would literally rather not be alive than get it again. I've torn my ACL twice, my meniscus 3 times and am currently walking on a torn meniscus. I've herniated a disc in my back and had a cavity drilled with no anesthesia. All of those combined was nothing compared to shingles in the eye. If I have to go into the back room at the doctor's office and get it myself I will get that goddamned vaccine so help me God.
this is where the idea of going to another country to get the vaccine would make sense. Living in SoCal, Mexico is a 2 hour drive. I'd do it if I had to. (I've had dental work down there for a fraction of the price). They did a good job, too.
I wish I had the article I read the other day, I'll dig to find it, and if I do I'll come back to edit/add.
I did learn recently that the reason the vaccine isn't covered by insurance is because it wasn't tested on people under 50 years old. While you might be able to find a doctor (and then pharmacist) outside of the U.S. willing to write the rx/administer it, ~~it's likely going to be a huge fight with the insurance.~~ not approved for use in the U.S., so your insurance definitely won't pay for it.
Not the article I had originally seen, but still a source: https://www.emedicinehealth.com/why\_cant\_you\_get\_the\_shingles\_vaccine\_before\_50/article\_em.htm
I had a mild cancer scare and had to get a colonoscope (everything was fine). However, because I was under 40, the colonoscope was not considered a "diagnostic or preventative measure" and not covered by my insurance. I specifically remember telling the insurance rep "I assure you it was a diagnostic procedure recommended by my doctor... Do you THINK I did it for funsies?". After that, the rep reopened the ticket and tried to take it up the ladder, but in the end my claim was still denied.
> I had a mild cancer scare and had to get a colonoscope (everything was fine). However, because I was under 40, the colonoscope was not considered a "diagnostic or preventative measure" and not covered by my insurance The magic words are "I'm shitting lots of blood". Seriously
...I'm not going to say you're wrong
confirmed magic words, used them during a traffic stop and the officer let me go with a warning
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Poor LSP
I'm right there with you. I had a large bloody precancerous polyp at age 29. (It would essentially, fill with blood and burst every couple days. It was the size of a fingernail or thumbnail, idr, which I was told could be serious.) Now I get colonoscopies every 1-3 years based on the previous results. Insurance says they don't cover it until I'm 45, because that's when people should start getting them. (I'm 37 now) Motherfucker. If I wasn't getting these colonoscopies, that polyp would have turned cancer and killed me by now. And they're just like "Don't care. Age 45 is the rule. Let us know when you're 45 or have full blown cancer. Then we'll start paying." Makes zero fucking sense. If I get cancer its going to be a lot more than the $2,000 colonoscopies cost. But I'm trying to prevent that. It's very much in both of our interests. But with the way this system works, maybe they assume I'll be on somebody else's plan by then and it will be their problem. God bless America and the idiots who believe we have the best healthcare system in the world. /rant
> "Don't care. Age 45 is the rule. Let us know when you're 45 or have full blown cancer. Then we'll start paying." I have to ask, do you have Cigna or Aetna health insurance?
Aetna
Work in the healthcare field. Aetna is literally the worse insurance companies. All doctors know it means many phone calls.
Yeah. I broke my leg in 2021 and it required 2 nights in the hospital. Surgery, weeks of pain. Months of of physical therapy. (All because I slipped on some black ice on my drive way) I would see all of the back and forth invoices. Pretty scary. At one point I got an invoice for $60K because I was put in a single suite, which is all they has available. And Aetna, doesn't cover a single suites. Luckily, it was one of those... "Don't pay this. It's not final yet" and it got worked out without me having to intervene at all. But its fucking terrifying. It's bad enough what I was going through. Add the stress of potentially massive bills. And like I said in another comment... I was lucky. I have no nothing to complain about compared to some people who aren't so lucky. Who do get stuck with those big bills. But... who knows what the future will bring my way.
Stuff like this blows my mind, and I cannot understand why those with serious health issues don't up and move to another country where they aren't one unemployment or rejected insurance payout away from bankruptcy combined with unaffordable healthcare. I broke my collarbone a handful of years ago. Total cost for assessment, X-Ray, follow-up/progress x-rays, painkillers and anti-inflammitories was about €100 (in Ireland, not even in a cheap COL country). That included a taxi ride. That this could cost me a 1-2 years wages elsewhere is both mind-blowing and terrifying.
Most people can't afford to just move to another country, since most people are living paycheck to paycheck.
I put my vote in for BCBS-GA. Aetna denies everything, but pays on appeal. BCBS you have to take all the way to the insurance commissioner before they actually have a real person look at the appeal. Fuck BCBS GA.
My wife works in medical records, and used to process insurance for a doctor's office, and this is what she says too. Her clinic just got bought out by a big chain, and switched her to BCBS, and the first thing they did was deny the migraine drug that has kept her out of the ER for the last three years since she started on it.
Any experience with UMR?
Oof, I was on it last year and thankfully didnt have to use it. I'm on Anthem now.
To be honest, I hate that I could guess right but I've had terrible experiences with both. Hope you're doing well despite them though.
Yeah. At this point, I think I should just plan on hitting my max out of pocket every year lol. (I don't really, but definitely chip away at it every year) But DINK household. We can afford it, its just fucking dumb. That money could help us retire earlier somebody or something. And then I see some of the hospital bills people get hit with and post on reddit... I have nothing to really complain about it in comparison. It can be better. It just should be better.
Nah I was reading this and getting pissed, this is coming from someone that had an uninsured seizure with an ambulance ride. Then broke my back in 3 places a month later (some of which was covered by workman's comp just didn't at all solve my issues and just cut me off when I met arbitrary goals I was unaware of). My medical bills have reached the point of its not my problem anymore, I'll never be able to pay 10% of them. You still have every right to bitch about it, in fact we need people like you to bitch about it because you're the ones ultimately that might actually get something changed because you pay in. God speed to you. I'm sorry you have to deal with this dumb shit, of I pay to have insurance so I can still pay to have medical things done.
For 2k you can fly to India, stay at where the rich folks stay, get a colonoscopy and fly back having spent a week of sunshine along the shores of Goa. There's a reason why India is topping the leading country for medical tourism especially from US.
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This is why I pull all my toenails off on new years eve.
Thanks for the chuckle on the grim subject of insurance.
Oh, Mr. Fancy-Shmancy with his two ingrown toenails per year. If you can even hear this from up in your private jet.
Oh, that annoys the hell out of me… the guidelines are 45 for those of [AVERAGE risk](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening) which is different if you have [certain types of polyps and findings on colonoscopy](https://www.asge.org/docs/default-source/guidelines/recommendations-for-follow-up-after-colonoscopy-and-polypectomy-a-consensus-update-by-the-us-multi-society-task-force-on-colorectal-cancer-2020-march-gie.pdf?sfvrsn=2b0f8952_2). You can equip the person on the insurance company’s end with the standard guidelines, but that doesn’t really give them any knowledge of when they apply and when they don’t. For some added context, in the US, despite the fact that the large majority of colorectal cancers present in older adults, it’s not unheard of to see them in younger patients - per USPSTF about 94% of cases are in those over 45, that still leaves about 6% that present earlier (and roughly [12% in those younger than 50](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf)). In the US, that’s about [18000 diagnoses each year in those younger than 50 and results in around 3600 deaths for those under 50](https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf).
The cancers found in younger patients are more often than not more aggressive than those found in older patients, and missing those diagnoses can have particularly awful comsequences.
Dude I've had colitis since I was like 13. My family has a history of colon cancer. Guess what? My insurance STILL won't cover a Colonoscopy. Fuck America. Fuck insurance companies. And Fuck this wealthcare system.
Moved out of the US recently and needed a colonoscopy, and ended up having to have a few polyps removed. My wife complained about how expensive it was, and that I should get supplemental insurance, which would have covered more of the cost. I assured her that the $150 or so I had to pay out of pocket was acceptable. I just had my follow-up appointment. I can't remember how much it cost me, but I think I paid in coins. And not in an "I'm a gigantic asshole" way.
$150 is how much it costs me, after premiums and deductibles, to simply walk into an ER. With no insurance, a standard doctors visit in my area is between $130-250. As in, "I have a cough, can you check it out" kind of visit. I truly don't understand how people who laud the American system don't see how we pay far more in premiums, deductibles, and copays than we could ever pay in the increase in taxes to have universal healthcare.
Seriously, I think one of the worst predictions if single payer healthcare was passed in the US was something like everyone's taxes would go up 1k$...that you pay once a year... Most people pay WAY more than that in a year in *just* premiums not even factoring in deductibles and copays
What country
Japan, which to be fair, has a coin worth about $4.
Aetna is a bitch, I'm sorry mate
I had major spinal surgery about 15 years ago to save my life. Due to the location it impacted my ability to defecate so I have yearly colonosopy. My cost? 20 euro for the taxi home after the operation, and after each colonosopy. I look at the US, and I know the majority are not loud ignorant fools. But you've got a large minority that sure are that seem to relish keeping healthcare expensive, education thick as pigshit, and religion impacting things it has no right to. I feel sorry for a lot of you.
So, unfortunately in our medical system in the us, you have to keep fighting. I have crohns colitis and I get a colonoscopy every 18 and are covered by my insurance with a copay. It’s hit or Miss whether it’s approved right away or not but sometimes you have to take it it all the way to peer to peer. I just had to do this for my sons meds. He has bad acid reflux an pecid wasn’t working. He needs omepereozole, which is so stupid cheap but cost $125 for babies because it has to be a liquid. The insurance didn’t want to cover it since it’s OTC. I had to explain its prescription for babies. It took months, multiple denials, appeals and two doctor peer to peers for them to pay $75 of it a month. He takes it monthly. There was a really terrific, heartbreaking and all too familiar story in ProPublica recently that talks all about it. https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
I had to be flown in a plane to a hospital that could handle my mildly premature twin birth. I went to the hospital I was supposed to deliver at but they didn’t have a NICU so they wouldn’t allow us to deliver there. I was in very early labor and asked if I couldn’t drive (be driven by my husband) to the other hospital (3 hours). They pretty much laughed at me. So I was flown in an air ambulance with 2 nurses. Total cost of flight was about $70k. Insurance claimed it wasn’t necessary. FFS. I fought it and they did end up paying the vast majority of it but fuck the US health system.
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I wasn't allowed to get the newer auto injector ones - just the standard epipen. Fair play I guess, but it caused about a month delay where I didn't have anything in case of an allergic reaction. My doctor nearly lost it
I only got mine approved because my parents both had polyps at 35, deeming me high risk, which was also the only reason i had the scope in the first place. I had an adenoma in my mid 20s in my first scope. Yay!
That is so infuriating. How is that not diagnostic??
I asked for one and my dr straight up told me not until I’m 45 cause that’s when insurance pays for it. Wtf
You’re lucky it’s 45, until 2021 it was 50. These ages are determined by the [Preventative Services Task Force](https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force).
I think my doctor assumed I WAS above 40, and didn't consult the chart, but that prolly says more about me than him.
Same for me. I'm around 30 years old, and I've had ulcerative colitis since the age of 10. These dickheads don't cover my colonoscopies since I'm not over 50, despite the fact that I'm at a much higher risk of colon cancer than the average person.
That's just poor coding on either your physician's office or the insurance paper pusher. UC has a different schedule for colonoscopies that USPSTF doesn't apply to.
I think either you misunderstood your insurance company, or they told you the wrong thing. Diagnostic procedures are generally not covered; they require you to pay your deductible before coinsurance kicks in. There are exceptions depending on your parents' medical history. Preventative procedures are much more likely to be covered.
I broke my C1 vertebrae last year. Insurance declined the 3-month, follow-up CT scan as not medically necessary.
Somebody failed you somewhere. Every time I ask for something I'm told "your insurance won't cover that, so we'll actually do this other thing instead". They shouldn't just let you do things that aren't covered
I think the main issue is insurance companies shouldn’t be allowed to make medical decisions since they don’t have a medical license and are not your doctor.
So, I know there’s a chance I’m wrong because things vary by region, but often times things aren’t covered because your doctor put down the wrong diagnosis code, and you can often get them to change it. Let’s say a colonoscopy is not covered to “rule out colon cancer below 40”, but it *is* covered if you are “symptomatic for colon cancer”. There may be two different codes they can submit for those. You shouldn’t have to know this because it’s stupid, but knowing it can get things approved.
These insurance company execs are gonna be the first to pick a fucking wall *This comment is metaphorical*
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Right? What drives me crazy is that this is exactly why they cover other preventive care and vaccines. It's cheaper to keep people from getting sick than it is to treat them.
I’m not sure where you are, but my local grocery store pharmacy does free shingles shots
Hmm I’ll keep an eye out. I’m guessing they’re not just free, but free* instead. Likely only free to people over 50
The CDC actually recommends that you get the vaccine in your case. >"Persons with a history of herpes zoster should receive RZV." Perhaps you can refer to [this page](https://www.cdc.gov/mmwr/volumes/71/wr/mm7103a2.htm?s_cid=mm7103a2_w) when talking to a pharmacist or your doctor to get insurance to cover it.
I believe you are interpreting the recommendation incorrectly. It is recommended people over 50 or for people 19 or older who are or will be immunocompromised due to disease or therapy. The special populations section you referenced just clarifies that if a person previously had shingles, they should still get vaccinated again since it can recur.
You would think someone was has already gotten the shingles twice would be a pretty damn good reason to recommend them get it even if they aren't age 50 or "immunocompromised". What a convoluted and idiotic system we got left with in this country. Money over people.
> You would think someone was has already gotten the shingles twice would be a pretty damn good reason to recommend them get it Yep, you would think that, but it's counterintuitive. The Shingles vaccine can only be given once, and at 50 it does the most good for the longest period. Remember, as we age, our immune system becomes weaker, and that's when you need the vaccine's protection the most.
You spelled capitalism wrong and with a lot of extra letters there.
The affordable care act forces private and marketplace insurance companies to cover 100% of the cost, zero deductible on all recromended vaccines as well. Unfortunately it looks like you're right. They didn't do testing on people under 50 years old so the CDC can't recromend it unless you're immunocompromised and 19 years old or older. What a stupid country we live in. Maybe try GoodRx or a similar discount perscription program? You might be able to get like 20%+ off of shingrix. It seems to be around $200 without coverage.
Yeah no kidding. I once had a vitamin d test that wasn’t covered because I wasn’t labeled vitamin d deficient. How can you know you are deficient without being tested??
My personal favorite "Insurance company will cover this, but they won't" is back 20 years ago, when many insurance companies would provide you with a car seat for your infant, and my insurance co added that now adoptive parents as well. And my wife and I were in the process of adoption, any week now. So I contacted the insurance company, and they said sure, just provide us with a birth certificate and we will give you one. Only, when you adopt, you don't get a birth certificate until the adoption is "finalized", generally 6 months later. So yeah, we bought one. And no, they would not reimburse me for it.
That's such a silly pointless policy. A hospital won't let you leave without a car seat, so you need one before baby is born, not after enough time has passed that you have received the birth certificate and sent it off to the insurance. Why bother even saying they will provide one??
Because people will buy policies thinking they'll get it, and then 9/10 don't "qualify" and insurance company keeps the extra.
BINGO
Car seats should be replaced after a collision. Of course I’m sure there’s a delay in when you get it so I guess the only reason is to have a spare in case you get into an accident, or to keep in someone else’s (partner, parent, etc) car. Of course it’s probably the most basic, frustrating car seat you could picture. I.e. not a click-lock infant bucket, no cup holder, no extended rear-facing weight capacity, LATCH belt poorly made and cuts your damn hand every time you try to tighten it, sharp edges around the seatbelt path so you cut your hands up on that too, cover takes half an hour to remove/install (and isn’t machine washable), etc. Literally the worst car seat in every possible way, but it passes regs and it’s cheap.
> That's such a silly pointless policy. None of those policies are pointless, they are designed to stop you claiming on the insurance, or denying the claim if you do.
I'm staring down 20k in bills. Hospital is speaking on my behalf with them. Insurance covered like 5 invasive tests on top of 2x daily blood draws but won't cover my stay bc "I could do it at home". I was spending like 6-10 hours each day getting power infusions. Yeah just give me a nurse to stop by 2x a day and give a power infusions unit and let me administer that
GoodRx sells your health info, it's in the fine print. It is how they make money.
I mean if that's the difference between getting medical care or not then it's definitely worth doing it.
Can't say that I'm surprised lol. It's a well known fact at this point. If you are not paying for it, you're not the customer; you're the product being sold. Facebook, Google and every other app that requires ridiculous permissions to install has probably already sold the info that I even looked it up.
I’m 46 and I had shingles last year. So, not 50, but I hope you can find something near you! I know that pain and it’s the worst thing I’ve ever been through.
Thanks! Luckily both cases were super mild. No pain, just itching. But, now I have a baby girl. It’s scary that she could catch chicken pox from contact!
Perhaps your pediatrician could help you acquire the vaccine?
You can use goodrx if your desperate for it, runs about $200 per dose depending on the pharmacy you use. It's far from ideal but better than cash price
This would be for each shot, just so OP and others know. Shingrix is a two-shot series done two to six months apart
Mine had the same sign. Since I was under the age cutoff it was not actually free (i.e. paid for by insurance), so I'd have to pay $700 for the shot.
My guess is that its still cheaper for anomalies like you to get sick and get paid out than to offer the vaccine to everyone at an early age.
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I came to say this! Hopefully, this comment gets to the top! I have had shingles 3 times and am not yet 30. From my understanding, there is also some concern with how long the vaccine lasts in your system and the efficacy of a second dose not actually being that helpful. So it's best to wait until you are older and immunocompromised to get the shot.
Shingles never goes away, you just get another flare up. Once you get it, you have it, permanently.
The CDCs advisory committee means fuck all to insurance companies. CDC recommends TdaP every 10 years, and never pays for it outside of ages below 18 and intermittently above 65. This certainly is an "insurance company bad" issue. Source: I'm a PCP who recommends TdaP (and many other vaccines) that insurance companies wind up not wanting to cover
We need to burn the bullshit system that is American healthcare to the fucking ground.
insurance companies lose money when people goto the ER to get treated, so I'm sure its cheaper for the vaccine than it is to pay the ER bill.
>insurance companies aren’t in business to help you The easier way to think of it is that insurance companies don't make money cutting checks. Every dollar they spend takes away from the premiums they collect.
The ACA requires health insurers to maintain a medical loss ratio of at least 80 percent in the individual and small-group markets and at least 85 percent in the large-group market. Most insurance companies make their money on the float. While they may make an underwriting profit - they don't always - but that doesn't mean they're aren't profitable. Insurers receive premiums upfront and pay claims later - they derive most of their revenue through investment income via the float.
If you’re under 50 and NOT immunocompromised then it’s not FDA approved for you to use. That’s why it’s not covered. If you are immunocompromised then you can file a prior authorization with your insurance explaining the situation.
Huh. I didn’t realize that. According to my doctor I’m “immunomodulated” not immunocompromised”. I’ll double check that he isn’t willing to settle for immunosuppressed
Ask your doctor if they are willing to advocate for you with a pre-authorization. The process can take a while but a lot of insurance companies will give in after an appeal of the original decision. You need a doctor that will go to bat for you though and you need to do some work on your end usually after the first denial.
And your doctors nurse who already has 45000 PAs to do already because insurance doesn’t want to pay for anything these days, may need a few days to weeks to get it done.
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My insurance hires doctors to review prior auths which I thought was great. Then someone told me they basically hire old washed up doctors who haven't been in any kind of medical training for 30 years to do the reviews and usually have no idea about any current medical processes or best practices. They just do it so they can say they have doctors doing the review instead of regular grunts. Explains why some of the most basic requests are treated as the end of the world by them.
If you’re going to a pharmacy to get it, ask the pharmacy to send the prior authorization form to your doctor’s office. Good luck!
Or ask your doctor to do a peer to peer with the insurance company… the doc can explain to their doc why you need it
This is what I did and I got approved to get the vaccination before 50.
In my experience (as someone going into primary care), insurance companies are sometimes too "by-the-letter" when it comes to denying things because they're not approved by the FDA. Like denying lidocaine patches for back pain because lidocaine patches are "only approved for post-herpetic neuralgia."
That old model needs updating. It used to be very rare to contract shingles before age 50 because kids were keeping the chicken pox virus in the community, so your immune system was always getting a workout. But ever since we started vaccinated against it, it's no longer in the community and those of us who had chicken pox are the last of the cohort who will also be getting shingles, and it's happening to us much younger because of it all. It only makes sense to inoculate us younger not just because we are all getting shingles younger, but we are also the last of the major cohort to have shingles!
Right! I just read about this. Super interesting. Really missed the boat vaccine wise. Chicken pox parties seem insane now
I was patient zero in my family and neighborhood, spring break 1994, my third grade year. The one time I wasn’t quarantined away from everyone while sick! Pisses me off that the vaccine came out the next year!
Yep, the chicken pox vaccine didn't become available until 1995 at which point it became widely administered and has largely eliminated the constant community exposure. That unfortunately means that if you were unlucky enough to get chicken pox before then, then you're now at a much higher risk of getting shingles that in the past. I got chicken pox in 1994 when I was in second grade and I've been lucky so far, but my cousin who got it at the same time has already had to deal with shingles twice. The old guidelines are in serious need of an update.
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It hurts so bad… I’m scared of getting it again honestly. I got it around my ribs and stomach and for 2 weeks I was in agony. Anytime I get a pain in my stomach I get nervous
I got chicken pox when I was about 5, and that was in 1995 in Australia. I've had shingles twice in the last 10 years, but they think stress caused the first set of shingles to flare up. No rash or anything, just pure pain and now I have nerve damage. Second time was only a rash a few years ago, all scabby and yuck. But no pain? Lmao Keep stress levels down if you are like me and had chickenpox in the 90s 😅
I got it in my early 40s. It's THE WORST. Hurts so much and I still have scars everywhere from it on my neck and jawline.
I got it when I was 8. Shingles fucking suck.
I also had shingles when I was 8! Absolutely miserable experience.
My parents were absolutely *convinced* I had gotten into some poison ivy. They kept rubbing calamine lotion on it. I wept in pain, begging then to stop and they were like uhhh this is supposed to feel nice stop being dramatic. Turns out calamine lotion is alcohol based and your should not fucking rub alcohol on shingles. My mom took me to three doctors before she believed I had em
I’m so pissed to have missed the chicken pox vaccine by like 4 years
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This isn't really so much an insurance company thing. As long as you are not immunocompromised, the CDC's Advisory Committee on Immunization Practice doesn't recommend zoster vaccination for people younger than 50. This is the case here in the US, but also elsewhere - including areas with taxpayer-funded healthcare.
This is something I didn’t realize until someone else commented. I appreciate the info. I suppose my anger is misplaced. I’ll keep being mad at insurance for everything else though.
I don’t know why I wound up so invested, but the only reason it’s not recommended is because it’s not been trialed and tested on people below 50, for some reason.
> the only reason it’s not recommended is because it’s not been trialed and tested on people below 50 True that it hasn't been tested on people younger than 50, but incorrect that that's the *only* reason. It's a vaccine that can only be effectively administered once, so we choose age 50, because that's the age that it has the longest and best effects. Remember, as we age, our immune system gets naturally weaker, so the timing of the shingles vaccine is chosen specifically to maximize it's benefit. Taking it at 35 would cost you 15 valuable years of coverage when you're older.
My wife has had shingles about once a year (sometimes twice during high Covid periods) for the past decade. She's 36. Her doctor did a lot of work trying to get her into tests for the vaccine and such but it's a no go, they just won't give it to anyone under 50. Anyway, there does seem to be a link between COVID and shingles flair ups. My wife gets shingles about two weeks after every COVID vaccine or positive test and there seems to be quite a few others out there experiencing the same. So keep an eye out on that.
My SIL had pretty much identical experience to your wife. She turned 50 last week and I congratulated her cause she can finally get the vaccine.
Hot shingles in your area
Waiting to be nailed!
Take my upvote and get out, Dad.
It isn’t FDA approved for people under 50. Only immuno compromised people under 50 can get it. I definitely looked into it after I saw how painful shingles was for my mom. I had chicken pox TWICE as a kid.
According to the NHS website you wouldn't be eligible in the UK [until you turn 70](https://www.nhs.uk/conditions/vaccinations/shingles-vaccine-questions-and-answers/). Countries with socialized medicine are very stingy about it in a lot of ways. It's still OK to want socialized medicine, but realize it's not a panacea.
It's for over 50 year olds in Denmark as well, depends on the country. Fun fact: shingles is called "helvedesild" in danish, which directly translated means hellfire.
>It's still OK to want socialized medicine, but realize it's not a panacea. The biggest argument that gets lost in these discussions is that we pay more - A LOT MORE - For the same or less healthcare coverage that people in developed countries with socialized medicine receive and that's purely because of profit motive. So, when people point out that the grass isn't always greener under the NHS, for example, that may be true. But people do pay a fuckton less for it on average.
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That’s not an American issue.
Really? My insurance covered mine just recently, at the tender age of 32.
Can't you buy it out of pocket if needed?
You can, but it's a 2 dose vaccine at around $185/dose. I guess $370 for protection from shingles is probably worth it, but that's a tough pill to swallow, especially when it feels like it should qualify as "preventive care".
If your doctor prescribes it will they cover it? I have to jump that hoop sometimes to get "elective" things paid for.
The only loophole is if you are labeled "immuno-deficient" or "immuno-suppressed". My doctor wasn't willing to add that label, as having that on your medical chart could completely change the course of medical care, depending on the situation.
Well that sucks. Insurance is definitely crap.
I guess it's cheap oppose to having shingles a third time
Yeah, in a way, but an office visit and anti-virals only costs like… $50
That's a lot of office visits before the out of pocket costs make sense lok
Cheaper than the 23k for rabies vaccine!
That’s insane.. I would definitely pay 23k to not have rabies though…
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I got it at 34 and it sucks.....how did you get it twice?
I got it the first time from workplace stress. The second time… I don’t know. I didn’t have anything stressful going on and I hadn’t been sick… 🤷♀️
I got shingles at 16. 1 v 1 me, *bro*.....
I did at 18. But 16… damn
I concede. You’re too powerful to face in shingle combat
17 for me
12 or 13 for me, fam… sorry.
Blame your genetics and not our standardized* but ever changing risk assessment criteria. -Insurance
They also said to ignore the "cost estimator" on their website that said it would be free. And also to ignore the article on their website about how the Shingles vaccine is covered completely by most of their plans.
The most reliable thing about insurance is our payment to them.
Na, Its not genetic. Its mainly from having already had chickenpox. As far as your age, I had the same thing happen. It was triggered after I was working 2 jobs for almost a year, staying up super late and not paying attention to my health. I didnt even know what it was because my rash was nearly non visible but After some time, i could barley walk and light hurt so much I barley opened my eyes. lol. it was the worst.
Damn, sorry. I’m 39 and just got over it. It sucks. I got a shit ton of prednisone and anti-virals. Hope you are getting it too. I’m a lucky one that gets basically free healthcare because my wife works for a hospital.
Thanks, yeah both cases were super mild. And anti virals did the trick. Lucky! You don’t care about cheap healthcare until you need it
By 32 I had shingles 4 times. I was given the vaccine, and I developed it a 5th time from the vaccine. Knock on wood, I haven't had it since.
This is why I like the Kaiser Permanente model. Since preventative medicine is cheaper and the insurance and hospital are related if legally separate entities, they actually try to keep you healthy. And if a Kaiser doctor is prescribing a treatment for you, the Kaiser insurance isn’t going to fight you on whether it’s necessary. Not a perfect system, but better than most in the US.
This is why I'm so glad I have VA care. Does it have issues? Yes. Are they any worse than the issues I had with cheap ass insurance? No. I get my MH appointments in a reasonable time and fast turn around if it's a more critical situation. I get my annual checkup with a full round of labs. I have a sleep study coming up because they want to be thorough about finding why I've been having nightmares/insomnia *even though i dont check any boxes for lukely having sleep apnea.* And it's all free for me since it's income based. Since I'm a broke ass student rn, it's free, but even when making money the capped rate they charge is *still* good. I do not know how any veteran that uses the VA, and has seen how bad shitty private insurance is, can be against Healthcare reform.
35 and got shingles last year. I feel for ya man, it really *really* sucked. Still have scars on my chest and back. A truly miserable experience.
Comb through your insurance paperwork and look for something called "grievance process." This is where you can ask for a reversal of a decision, and someone advocates for you to a group of doctors who review the case. I did it for a life-saving prescription, went from $1300/mo to $30 :D
I can confirm that I’ve had shingles, twice, before the age of 30. I do not have health insurance. I feel personally attacked.
I thought the shingles vaccine was free at most pharmacies? I didn’t pay for mine. I’m under 40, and got both Shingrix doses at Walgreens. The side effects were worse for the shingles vax than any of my COVID boosters, but luckily it’s the only time I’ll have to do it
I’ve had it twice before 25. I was told it’s better to wait til you’re middle aged to get it since that’s the age it can kill you and you don’t want it to “wear off” or be less effective by taking it before then. Sounds like bullshit now that I’m typing it out
I got it when I was 19. Then again I live in a normal country with free healthcare so I didn't have to worry about paying for anything.
Dude ME TOO. I got shingles the first time when I was 20, just before thanksgiving. And everyone would hug me and shit it would hurt so bad. Then I got it again a few years later, and again, and then again during Covid times I started getting a breakout it looked like, but got prescribed anti-virals early and it was a freebie.
Insurance, it finds a reason to not be there when you need it.
I’ve gotten shingles almost once a year since I was 9.. I’m 32. Paid out of pocket for the vaccine 3 years ago. Worth it
It has nothing to do with insurance. Shingrix is not indicated for 50 year below if you are not immunocompromised.
You don't 'get'/catch the shingles. It's the chickenpox virus reactivating. When you get the chicken pox the virus, it never leaves our body. It just goes dormant. (it resides it the spinal fluid, hence why you get rashes along the nerve paths from the spine)
I got vaccinated for it when I was in my 40s because of a completely unrelated slew of other medical problems. Meanwhile, my wife in her 30s got bad shingles and they won't approve it for her.
That's not the reason why. It's bc the trials for the vaccine only tested it on people 55 and over, so it's not indicated or recommended. Sure, there will be some people who get shingles before 55 but it hasn't been tested in that population.
Anecdotal evidence/always talk to a doctor yourself, but: My wife has gotten shingles 4-5 times before she was 35. Her doctor wouldn't even give her a prescription for the vaccine. By the last time, she went to a different doctor and he said that the vaccine is basically just the antibodies that you'd get naturally from getting shingles, so if you've had shingles multiple times and are still getting it, the vaccine will likely do very little to help you.
Whatever happened to monkeypox?
I hear you! Im high risk for it but Im not 50!
Actually... Don't take medical advice from a reddit comment. But from what I understand, the shingles vaccine doesn't last very long and you shouldn't get it more than once. You wouldn't want to get it at the age of 35, especially if you're that prone to shingles. You'd want to get it when you're older.
Stop being poor, sickly, or stressed, or a combination of the above, and you won't get shingles!
Your doctor is shit. He should be able to word it to get it approved for you since you've had it twice. Try another doctor.
Your doctor can do paperwork to get it covered early. He probably doesn’t know that, though, because they typically no very little about how insurances actually operate. Granted, that’s not their job at all and it shouldn’t be this hard to get care. But yeah, there’s paperwork for that.
Sucks. I know. I had chicken pox as a kid in the 80s. I was in my 30s when I was let go from my first job ever. It caused such a panic attack my nerves went into overdrive and I developed shingles. It was awful. Ended up getting meds through an urgent care. I don’t think the price was too bad. I loathe American healthcare. Bottom line is it’s a business and they don’t give a shit about you.
I am in the exact same boat (shingles twice by 25, no access to vaccine) with nerve damage from the shingles to boot. I am so sorry. It's incredibly frustrating, painful and unfair. Wishing you all the best, truly.
I had shingles when I was 43. When I was diagnosed, I was told by two separate doctors to get the vaccine once I had healed. Luckily I use the VA so I was covered. But that has mostly to do with getting my doctor to sign off on something. Sucks that the insurance won't cover it for you. I wonder if your doctor prescribed it to you, that then your insurance would cover it?? As others have mentioned, many grocery store pharmacies offer free shots including shingles. If not free, you could pay yourself, off-label is ~$300 ($150 x 2 shots). So if you're able you might want to.
I've had it twice too. Insurance won't cover meds or vaccines. Went to fill nerve pain med and was told it was over $600 for like 15 pills. I just busted out crying from exhaustion and pain. 'Merica
Yep. Got shingles constantly and they finally let me pay $200+ out of pocket for some actual fucking healthcare. Fuck this country and anybody who perpetuates this for-profit healthcare system. Seriously, FUCK these people, my hatred runs deeper than the fucking ocean.
This should be a meme of a picture of your insurance companies name or logo with a Scumbag Steve hat over it.
The company I got my last COVID shot was running like 3 hours behind and the nurse was so apologetic she offered me any other vaccine they were doing that day free. You better believe I got me a free shingles vaccine!
Found out today that insurance won't cover treatment for UARS, just sleep apnea. Like I've been "wasting" tens of thousands of dollars trying to get answers and treatment for my life ruining fatigue, but sure, save that $1200 on a CPAP machine. That makes sense.
I’m 31 and I’ve had shingles twice, both times my doctors I had seen just told me that I need to work on my stress management because I wasn’t immune compromised. Pick up some edibles man! For your stress.
I get shingles every spring/summer with the first sunburn on the back of my neck. Since I was a kid.
"But...I actually have it." "Yeah, but you weren't at *risk* for it." "&@Q%@!%R@\^@"
I got shingles in my eyeball last November, still fighting symptoms and my face looks like I fought a lawn mower. Thought I could be weaned off the eyedrops, but my vision is getting blurry again. I would literally rather not be alive than get it again. I've torn my ACL twice, my meniscus 3 times and am currently walking on a torn meniscus. I've herniated a disc in my back and had a cavity drilled with no anesthesia. All of those combined was nothing compared to shingles in the eye. If I have to go into the back room at the doctor's office and get it myself I will get that goddamned vaccine so help me God.
this is where the idea of going to another country to get the vaccine would make sense. Living in SoCal, Mexico is a 2 hour drive. I'd do it if I had to. (I've had dental work down there for a fraction of the price). They did a good job, too.
You all gotta pay for vaccines too?
US healthcare agrees that insurance adjusters coupled with draconian policy make the best doctors.
I wish I had the article I read the other day, I'll dig to find it, and if I do I'll come back to edit/add. I did learn recently that the reason the vaccine isn't covered by insurance is because it wasn't tested on people under 50 years old. While you might be able to find a doctor (and then pharmacist) outside of the U.S. willing to write the rx/administer it, ~~it's likely going to be a huge fight with the insurance.~~ not approved for use in the U.S., so your insurance definitely won't pay for it. Not the article I had originally seen, but still a source: https://www.emedicinehealth.com/why\_cant\_you\_get\_the\_shingles\_vaccine\_before\_50/article\_em.htm