I was born in 1970 and am reasonably sure my parents had me appropriately vaccinated. But I do not have a relationship with them, nor would they be reliable reporters. My mother actually kept out records for years in our baby books, but those were tossed by my brother. Soooo … I’m relying on the fact that my college dorm required me to get some updates before I could move in as the only real verification of my immunizations.
My partner was born in the 1963. So yesterday afternoon, we both assumed we were in the ‘vaccinated pretty well, but not at the highest level’ group. In other words, we both trust science and medicine enough to believe that we won’t likely be infected by the measles AND that if we did, our general healthcare privilege would get us through that illness.
Sunday evening, I started a FB discussion about vaccinations and fear based decisions. I was wrestling with whether my gut feeling that I should get another booster was driven by rational thought or fear. I’m still not really worried at this point that a bout of the measles would be devastating to me, but I genuinely hate the thought of how scared parents of very young babies or those who cannot be vaccinated must feel. So I launched a conversation.
So my working knowledge at that point was that anyone born before 1957 was presumed immune because of exposure, that vaccinations started in 1963 and were improved significantly in the early 1970s. So anyone vaccinated between that point might have the lessened immunity of 93%. Those of us born after 1970 had the two boosters and were at the 97% immunity level.
After the discussion on my FB page, people whom I consider reliable reporters mentioned that anyone vaccinated before 1981 were at the 93% immunity AND that as a person with asthma, I might be considered high risk. I hadn’t considered that.
This is when I sent my PCP’s office a message via the MyChart app to get her input on my status and next steps.
At this point, I understand that they can use a titer blood test to detect antibodies for measles, mumps, and rubella and then determine if an additional booster is warranted. That makes sense. Let’s not all rush in for a booster we don’t need, especially in eras when excessive use of antibiotics and pain medications have compromised the health of millions of people. And of course we want to be conscious of shortages.
And this is when people began reporting that UPMC and Highmark insurances would not cover the bloodwork, but would cover the additional booster if recommended by a doctor. What? That sounds ridiculous. Why skip a sound step in the scientific assessment of risk?
So this morning, my PCP staff contacted me and said I could go for a titer at the Allegheny Health Network lab BUT it wasn’t going to be covered. They told me I had to call the lab to get the codes (?) and then call my insurance company. And then call the PCP back to request the script.
I decided to call Highmark’s dedicated City of Pittsburgh health insurance team. She confirmed that Highmark does not cover titers as part of routine wellness exams and told me that even if my doctor determined me to be high risk because of asthma OR if I reported exposure, they would not pay for the titer. They would pay for the booster.
And she acknowledged how backwards that was. I asked her if my doctor was obligated to give me the booster without the bloodwork and she said no, that my doctor could decline and I would have to go to a clinic. I then asked if my year of birth and status as a person with asthma definitively meant I needed a booster and she said Highmark can’t determine that.
Then she told me that is was anyone born before 1989 who had the weaker immunity levels. So we’ve gone from 1970 to 1981 to 1989. That’s a pretty huge disparity in information.
Now mind you, this Highmark phone rep did not know about the outbreak of measles in Pittsburgh. Shame on Highmark. To her individual credit, she told me she was going to call my PCP for me and call the AHN labs and get a complete picture and then call me back.
So I realize I’m fine. If I wanted to go, I could drive to the Health Department and get the titer and booster. I can probably afford the out of pocket in-network fee of $48 Highmark charges for the titer. Now I’m just curious and eager to get to the truth.
So many of us are on Facebook ranting about anti-vaxxers, but we also need to invest that energy into educating ourselves on how a world class health care City like Pittsburgh is handling this process. It is absurd that Highmark and UPMC shift the burden to the Allegheny County health department. Isn’t this the moment when being local private non-profits subsidized by public taxes we shoulder for them should create a combined and reasonable response by these two healthcare giants?
It is a $48 testing fee for the titer which means Highmark’s real cost is much lower. Isn’t it good public health policy to encourage people with questions or possible exceptions to get the test so they can see their actual level of immunity, instead of guessing based on a sliding scale of information? Highmark and AHN have labs on the Northside where some of the more recent public exposures took place. Just cover the test and urge people to register.
And wouldn’t it be a strategic move to take the high road as the Supreme Court battles out the egos of these health giants? A friend told me that UPMC is giving free vaccinations to all employees which seems great, but what about their customers?
I’d like some local health reporters to dig into the insurance coverage issue and put it in perspective with their tax-exempt status and the limited resources of the County Health Department. What good does it do to educate people that they might need to call their PCP if they, like me, end up in a frustrating cycle of phone calls?
UPMC and Allegheny Health Network must do better.
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