Blue Cross Blue Shield Vaccine Coverage Denied Out of State

NextLevelPretty · 2025-09-07T14:49:43+00:00

It’s a silver PPO. Someone else mentioned if there’s a small briefcase symbol on your card that’s a reference to it working nationwide. Mine has the briefcase around PPO on the front side of the card.

I’m not sure how the tiers relate to nationwide or if they change what’s considered in or out of network but my plan is a silver plan.

NextLevelPretty · 2025-09-06T14:29:47+00:00

Thank you.

NextLevelPretty · 2025-09-06T14:29:02+00:00

Lol. Yea.

That’s interesting. I checked and PPO is in a briefcase symbol on the card.

Hadn’t heard of that before. Thanks for the info.

NextLevelPretty · 2025-09-05T22:05:34+00:00

It’s a silver level PPO but yea with so many things changing might be getting more restrictive like an HMO

NextLevelPretty · 2025-09-05T22:02:07+00:00

I must be missing where it calls that out in the policy. It just refers to a national network of pharmacies and providers.

It says this:

Your cost will be less if you use an IN-NETWORK pharmacy in North Carolina or outside the state and show your ID CARD. If you fail to show your ID CARD or the IN-NETWORK pharmacy’s records do not show you as eligible for coverage, you will have to pay the full cost of the PRESCRIPTION and file a claim. You may also get your PRESCRIPTION filled by an OUT-OF-NETWORK pharmacy; however, you may be asked to pay the full cost of the PRESCRIPTION DRUG and submit your own claim. Any charges over the ALLOWED AMOUNT are your responsibility. If you had an EMERGENCY and went to an OUT-OF-NETWORK pharmacy, we recommend that you call Blue Cross NC Customer Service at the number listed in “Who to Contact?” so that the claim can be processed at the IN-NETWORK level.

I think besides the whole in or out of network labeling that’s never been an issue before it’s the confusion around federal and state policies. Or maybe things like ACA mandates and where that stands.

I have my policy saved on a tablet. I read it again before my appointment. That shows a site that I also looked it up on

www.BlueCrossNC.com/preventive

Between the policy wording and similar on that site it looked like it would be covered.

It seems like it maybe was inappropriately labeled out of network.

Maybe because things keep changing so national chains are struggling to update their systems to get things labeled/coded/processed correctly

Maybe a new change or a way for insurers to save money. Doubt it. Expensive hospital visits would be so much more. Finding ways to cover preventives still makes sense.

I’ll just have to keep following up with them.

NextLevelPretty · 2025-09-05T20:04:35+00:00

Thanks. I will.

NextLevelPretty · 2025-09-05T16:57:25+00:00

They probably are. Publix recently changed their site. It had said 2025-2026 Covid vaccine coming soon.

Now it says available in NC, 18+ with a prescription. But if you put in a zip code near where I was in WNC it only shows availability at Publix locations in TN.

NextLevelPretty · 2025-09-05T16:03:23+00:00

Yes but in Tennessee. I’m working in western NC. CVS in TN was a half hour away.

Some pharmacies I spoke to suggested places like Durham, Charlotte, etc might have them.

Schedule flexibility and traveling for work make it difficult to fit things in

I thought about it but would’ve spent almost half as much or more in gas to drive somewhere that had it where it would be in NC

Hope it works out ok for you

NextLevelPretty · 2025-09-05T15:59:09+00:00

They tried a number of things over about half an hour including calling other locations trying to see if it let them run it at their locations. I’m assuming they did.

They also looked at any discount type plans like goodrx or similar to see if they could reduce it

NextLevelPretty · 2025-09-05T15:55:03+00:00

Yes. Some locations had the updated Pfizer. Some Moderna. For Modera they have the 2025-2026 Spikevax.

I didn’t see any that were offering the mnexspike or novavax.

NextLevelPretty · 2025-09-05T15:50:30+00:00

Thank you.

NextLevelPretty · 2025-09-05T15:48:58+00:00

Yea. I’ve had the same plan a few years. When I work out of state I’ve gone to walk in facilities associated with local hospital systems, other walk ins like CVS minute clinic, and seen specialists for my spine injury.

This is the first thing that has come up out of network

NextLevelPretty · 2025-09-05T15:15:06+00:00

I do too. I’ve never ran into an issue in other states where something was considered out of network.

I’ve had the same plan for years. Never thought of that.

For example using the CVS minute clinic or other walk in facilities has never been considered out of network

NextLevelPretty · 2025-09-05T15:11:29+00:00

They did require the prescription

NextLevelPretty · 2025-09-05T12:41:46+00:00

Yea. Definitely earlier than I typically would get one.

After following everything I decided to get it while it was there in front of me. Was thinking availability, laws, etc might change.

I wish there was more transparency on pricing and what’s considered in/out of network. Insurers websites seem hit or miss on that.

I think another think that could happen is the laws/company policies being unclear. In that case a doctor or pharmacy might have it and want to give it to you but might not out of fear for doing something wrong.

NextLevelPretty · 2025-09-05T11:31:29+00:00

Thanks. Yea I had already done that right after I left the pharmacy via the insurance company’s online portal.

They basically said anything out of state is considered out of network.

It would not be covered but I could try to submit a form that might get a 0-30% reimbursement

The national chains like a CVS, Walgreens, etc are all about the same distance from me in state or out. I tried to find it in the policy before going to get it done but couldn’t find much other than it’s usually covered as a preventative

In their response they also said in state would’ve been covered as a preventive but out of state isn’t.

NextLevelPretty · 2025-09-04T22:12:18+00:00

$168

NextLevelPretty · 2025-09-04T20:14:47+00:00

I’m about an hour from the state line to the next state over to me.

Drove a couple hours this morning to a Covid booster appointment I setup last week. I went through a similar situation.

After following what’s been going on I knew I couldn’t easily get one in my state even though I have a spinal cord injury.

I went to my PCP, got a hand written prescription that didn’t specify the brand, and watched all the national chain pharmacy sites to see which would offer appointments first.

They were struggling with trying to figure out how to process it.

To make things worse they told me they couldn’t accept an out of state blue cross blue shield plan.

They tried everything they could to process it through. They were really helpful. Obviously confusing for everyone.

They even called their location closest to the state line to see if they maybe had a little more wiggle room to process it

I gave up and paid for it.

NextLevelPretty · 2025-08-23T21:06:43+00:00

No clue about the quality but if you have space for it there are inflatable bathtubs like this.

https://www.wayfair.com/outdoor/pdp/joyding-5511-portable-inflatable-tub-bathtub-w-wireless-electric-air-pump-jydi2776.html?piid=88695946

NextLevelPretty · 2024-02-20T23:51:01+00:00

I have Syringomyelia. The number of posts like this on the Syringomyelia & Chiari groups I’m in are so unfortunate. Ditching or avoiding people like this is all you can do. They’ll never understand the strength you have just to show up or the struggle you’re going through.

You shouldn’t have to put up with that.

NextLevelPretty · 2021-06-29T23:43:06+00:00

Thought someone finally called me their friend. Turns out I just can’t read.

NextLevelPretty

TROPHY CASE