Letter to the Editor: Medicare Denied Payment For Whooping Cough Inoculation

Whooping cough inoculation is not covered by Medicare unless deductible is met, letter writer says

To the editor:

For several months, public health officials have recommended on their Web sites and through notices on radio, TV and newspapers, including the Patch, that in this area we are in a crisis with a Whooping Cough epidemic. The advices is that we should  all get a whooping cough inoculation. 

We have Medicare coverage with a supplementary, secondary, insurance policy for all charges in excess of what Medicare pays.  I have now received a statement from my doctor for the total charged, for $68.50. When I questioned my doctor I was told that Medicare had denied the charge. I then called Medicare and was informed that the doctor was correct.  Whooping cough inoculation  is not covered by Medicare but they had forwarded the statement to my secondary insurance carrier.  

When I asked why this was not covered he informed me that Congress makes the rules.  I then called the secondary insurer and was told that they had processed the claim and had credited the amount to my annual deductible.  It appears that when  Medicare denied  all payment and forwarded the statement to my secondary insurer, they, the  backup insurer then became the primary insurer and as  primary insurer they have a $150.00  annual deductible.

If Medicare had paid any portion of the charge the secondary insurer would have paid all of the remainder. But since Medicare paid nothing the secondary insurer then became the primary insurer and I paid since the deductible had not been met. The rules seem to have changed.  I reviewed the Medicare Handbook and all the literature from my secondary insurer and none of this is discussed. Please inform your readers ,who are covered by Medicare, that Medicare will denied payment for the inoculation.

Jim Adams

Lake Forest Park


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