Wiki Shingrix given under 50

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nbuck

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We had a 48 y/o get a Shingrix vaccine (which is too young). It was ordered because she had a recent shingles outbreak. Do you think I could use a history of diagnosis code? I just wondered what anyone else's experience in this might be and if you'd had any luck getting it paid. Thanks!
 
Well, since the prescribing information specifically states over 50, you may not get it covered. Did you try to get a pre-auth or have you already given the vaccine?
 
You could appeal for medical necessity, but I think you're probably going to end up eating the cost.

This may be a good lesson in checking benefits before providing a service.
 
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