Do I need all these vaccinations or is this a ripoff attempt by doctor ?

[strangefella]

Need to get the medical exam done and here is what the office of my primary care physician quoted me. Comes out to a total of 745. When I check the older posts, some have reported getting it done for $300-400. I can't find a single doctor for that sum in my area.

I was born in India and MMR wasn't available back then, I got BCG and DTP shots when I was a kid, and I don't have any certificate/document as proof of getting those shots. I had a skin test for TB done when I first came to attend school. I have never had any of the other vaccinations other than the flu shots.

Immigration Physical 145
Hep A 90
Hep B 95
Varicella 180
Influenza 32 (already got flu shot)
MMR 105
Admin of multiple vaccines 35
TB test 45
Gono 60
Total of ~750

Do I even need all these shots ? The vaccinations requirements page of USCIS lists only mumps, measles, rubella (MMR), polio, tet**** and diphtheria toxoids, pertussis, haemophilus influenzae type B, hepatitis B and any other vaccine-preventable diseases recommended by the ACIP as required vaccines. I wonder if this list is a ripoff attempt by the doctor's office.

[someAlphabets]

Hi,

You can save some money if you get the vaccines done by government clinic in your county as the vaccines are cheaper in a government facility. Ask the doctor who is going to take your medical exam that if it is okay to do so and will the doctor put up the same in the medical sheet based on the Immunization record given by the government clinic.

Also, do try to call all the USCIS affiliated doctors close to you as they all might be having different fees for the same exam.

Thanks!

[Smiley0722]

Need to get the medical exam done and here is what the office of my primary care physician quoted me. Comes out to a total of 745. When I check the older posts, some have reported getting it done for $300-400. I can't find a single doctor for that sum in my area.

I was born in India and MMR wasn't available back then, I got BCG and DTP shots when I was a kid, and I don't have any certificate/document as proof of getting those shots. I had a skin test for TB done when I first came to attend school. I have never had any of the other vaccinations other than the flu shots.

Immigration Physical 145
Hep A 90
Hep B 95
Varicella 180
Influenza 32 (already got flu shot)
MMR 105
Admin of multiple vaccines 35
TB test 45
Gono 60
Total of ~750

Do I even need all these shots ? The vaccinations requirements page of USCIS lists only mumps, measles, rubella (MMR), polio, tet**** and diphtheria toxoids, pertussis, haemophilus influenzae type B, hepatitis B and any other vaccine-preventable diseases recommended by the ACIP as required vaccines. I wonder if this list is a ripoff attempt by the doctor's office.

Hi! I dont think those are all needed. Did you consult already Doctors accredited by the USCIS?

I just had my medical last Feb 2018.
These were all the vaccines they gave me
- FLU
- MMR
- TB Test

- Syphilis ( urine test )
- Physical exam

I got most of them in the public health clinic.

I only spent around $400 for everything. But if your physician will do it everything for you, they will charge you around $700.

[UScitizenFilingforspouse]

Need to get the medical exam done and here is what the office of my primary care physician quoted me. Comes out to a total of 745. When I check the older posts, some have reported getting it done for $300-400. I can't find a single doctor for that sum in my area.

I was born in India and MMR wasn't available back then, I got BCG and DTP shots when I was a kid, and I don't have any certificate/document as proof of getting those shots. I had a skin test for TB done when I first came to attend school. I have never had any of the other vaccinations other than the flu shots.

Immigration Physical 145
Hep A 90
Hep B 95
Varicella 180
Influenza 32 (already got flu shot)
MMR 105
Admin of multiple vaccines 35
TB test 45
Gono 60
Total of ~750


Do I even need all these shots ? The vaccinations requirements page of USCIS lists only mumps, measles, rubella (MMR), polio, tet**** and diphtheria toxoids, pertussis, haemophilus influenzae type B, hepatitis B and any other vaccine-preventable diseases recommended by the ACIP as required vaccines. I wonder if this list is a ripoff attempt by the doctor's office.

It's not a rip-off attempt. They likely quoted you the cash price. Did you give them you insurance information so they could run a claim?

You're not expected to get the immunizations from the civil surgeon. The I-693 - Report of Medical Examination and Vaccination Record, is exactly that a report. Thus, if you have all your records - which moving forward, you should make an attempt to keep updated-; all the civil surgeon is going to do is transfer most of the information on your records to the I-693. So in theory, the I-693 could be relatively inexpensive.

In order to help you better, let us know where you are - at least the state, so we can tell you, "go here. or such state has free vaccination programs through this organization.

Start by reading the I-693 instructions. They state to "not attempt to meet the requirements before the civil surgeon evaluates you, in case any of the required vaccines are not medically appropriate for you". The instructions are also very specific on some things you have to do and the physician has to do. Be familiar with them so you can make sure the civil surgeon follows his to the T.

Are you still in your Phd program? If you are, you should still have access to the graduate student health plan. Make an appointment for a "titer lab report". They will measure the presence and amount of antibodies in blood. Bring the I-693 for the nurse to know what tests to include. Let them know, you've had the BCG. They should skip the X-ray because a. costs more than the IGRAs (Interferon Gamma Release Assays) and b. IGRAs are the preferred method of testing for TB if you've had the BCG vaccine.

There CDC recognizes 3 IGRAs for immigration purposes:
1. the QuantiFERON - TB Gold (QFT-G) test;
2. the QuantiFERON - TB Gold in Tube (QFT-G IT) test;
3. the T-Spot TB test.

Some of the younger medical residents have only read about the BCG in textbooks. And you may end up paying extra for an X-ray for no reason; only to have to go back and get the IGRA done anyhow.

Truth is that if they had to do a TB test for your PhD program, they probably did titers, too. You may not remember or were not paying attention. Who knows? Believe me, they were not just going to let you run campus without proof of immunizations. So before you even order titers, ask if they have been done. Ask for your records at school. It may all be there.

All the best.

PS: Did you ever send in that marriage license?
PS2: unless you are in a state with very fast processing times, the consensus here is to wait until USCIS sends you a courtesy letter requesting that you bring the I-693 to the interview. Some field offices, like mine, can take up to 24 months to process a family based AOS petition. The validity of the I-693 is limited. You have ONE year to submit it from the date the examination is completed. From the date it is received by USCIS, it is considered valid for adjudication purposes for ONE MORE year. So if you time it properly, you can get almost 2 years out of this transaction.
Most people run into trouble by sending it in right away which uses up that initial ONE year window to submit it. So you're left with one year of validity. They show up to the interview and their case gets delayed because the I-693 is considered expired then.

[strangefella]

Thanks for your responses!

Hi,

You can save some money if you get the vaccines done by government clinic in your county as the vaccines are cheaper in a government facility. Ask the doctor who is going to take your medical exam that if it is okay to do so and will the doctor put up the same in the medical sheet based on the Immunization record given by the government clinic.

Also, do try to call all the USCIS affiliated doctors close to you as they all might be having different fees for the same exam.

Thanks!

That is what I did today, called like 10 doctors. Most are asking for insane amounts like this. I will call more doctors tomorrow. This doctor for sure wants me to get the shots at his place, not the Giant pharmacy or government clinic.

Hi! I dont think those are all needed. Did you consult already Doctors accredited by the USCIS?

I just had my medical last Feb 2018.
These were all the vaccines they gave me
- FLU
- MMR
- TB Test

- Syphilis ( urine test )
- Physical exam

I got most of them in the public health clinic.

I only spent around $400 for everything. But if your physician will do it everything for you, they will charge you around $700.

What was the TB test like ? Was it a blood titer test ?
One more thing, did you have trouble finding a doctor that accept shots taken at government clinics ?

It's not a rip-off attempt. They likely quoted you the cash price. Did you give them you insurance information so they could run a claim?

You're not expected to get the immunizations from the civil surgeon. The I-693 - Report of Medical Examination and Vaccination Record, is exactly that a report. Thus, if you have all your records - which moving forward, you should make an attempt to keep updated-; all the civil surgeon is going to do is transfer most of the information on your records to the I-693. So in theory, the I-693 could be relatively inexpensive.

In order to help you better, let us know where you are - at least the state, so we can tell you, "go here. or such state has free vaccination programs through this organization.

Start by reading the I-693 instructions. They state to "not attempt to meet the requirements before the civil surgeon evaluates you, in case any of the required vaccines are not medically appropriate for you". The instructions are also very specific on some things you have to do and the physician has to do. Be familiar with them so you can make sure the civil surgeon follows his to the T.

Are you still in your Phd program? If you are, you should still have access to the graduate student health plan. Make an appointment for a "titer lab report". They will measure the presence and amount of antibodies in blood. Bring the I-693 for the nurse to know what tests to include. Let them know, you've had the BCG. They should skip the X-ray because a. costs more than the IGRAs (Interferon Gamma Release Assays) and b. IGRAs are the preferred method of testing for TB if you've had the BCG vaccine.

There CDC recognizes 3 IGRAs for immigration purposes:
1. the QuantiFERON - TB Gold (QFT-G) test;
2. the QuantiFERON - TB Gold in Tube (QFT-G IT) test;
3. the T-Spot TB test.

Some of the younger medical residents have only read about the BCG in textbooks. And you may end up paying extra for an X-ray for no reason; only to have to go back and get the IGRA done anyhow.

Truth is that if they had to do a TB test for your PhD program, they probably did titers, too. You may not remember or were not paying attention. Who knows? Believe me, they were not just going to let you run campus without proof of immunizations. So before you even order titers, ask if they have been done. Ask for your records at school. It may all be there.

All the best.

PS: Did you ever send in that marriage license?
PS2: unless you are in a state with very fast processing times, the consensus here is to wait until USCIS sends you a courtesy letter requesting that you bring the I-693 to the interview. Some field offices, like mine, can take up to 24 months to process a family based AOS petition. The validity of the I-693 is limited. You have ONE year to submit it from the date the examination is completed. From the date it is received by USCIS, it is considered valid for adjudication purposes for ONE MORE year. So if you time it properly, you can get almost 2 years out of this transaction.
Most people run into trouble by sending it in right away which uses up that initial ONE year window to submit it. So you're left with one year of validity. They show up to the interview and their case gets delayed because the I-693 is considered expired then.

Yes, I did ask them about the insurance. They flat out said that my insurance (CF BCCS) won't accept it. Heck, they did not accept my wifes claim of emergency rabies shot. I am in Maryland.

Yes, they did do a skin test for TB for all international students. I passed, but some friends got a false positive and they had to get a chest X-ray done.

I have health insurance through the school as I technically I am employed here. Are you recommending that I get the titers done first and then go to the doctor to get the shots ? I know that in Maryland it takes over 12 months to get the interview.

Yes, the marriage certificate was submitted. No issues there.
I was under the impression that I have to send in the I-693 when I submit the whole package. No ?

[S_R_E]

You need proof of vaccination for your immigration medical, the vaccinations do not need to be done by the doctor doing your immigration medical.

When I called around to find a local authorized Doctor to do my immigration medical I asked what what was needed at the exam and they mentioned the proof of certain vaccinations. I asked if those could be performed by my own Doctor and they said yes, all they would need would be a vaccination record from my Doctor. I already had an appointment scheduled with my Doctor and I called the office beforehand to mention the vaccinations I needed and what the cost was for each. It turns out they were all covered under my insurance, My Doctor administered any vaccinations I was missing and needed and they then printed out my full vaccination record which I took to my immigration medical and they just used that to transcribe the results.

Any Doctor who claims they must personally administer the vaccinations for the purpose of your immigration is not telling the truth. If you were already current on all of the vaccinations and gave them a valid vaccination record, would they insist you had the vaccinations again?

[miiki]

That list is mostly the recommended vaccines that most Americans receive. You could pull out Hep A (most don't get the Hep A vaccine). I'm not sure what gono is.

If you've had chickenpox before, you may have a positive varicella titer and not require immunization. Of course, talk it over with your health provider since I'm just an annonymous person on the internet.

A TB skin test is when they inject a small amount of liquid just under the skin. You must return in 48 to 72 hours for the nurse to determine whether there was a reaction. If you've ever been exposed to TB in your life, it will be positive whether you got sick or not. A chest xray is then used to identify whether there is an active infection. The results of the TB skin test are usually only good for a year. I'm fuzzy on the specifics on whether USCIS will take an old TB skin test.

You should be able to get many of the vaccines free/low cost through the student health center or your county health unit. Also, your insurance will likely cover the vaccinations as part of a annual wellness exam by a regular doctor or nurse practitioner (separate from the immigration medical exam). Then just bring the documentation to the civil surgeon and they can fill out the paper with that. Just remember, if you had the shots in another country, they would accept that documentation. It's no different if you get them somewhere here.

[UScitizenFilingforspouse]

I was under the impression that I have to send in the I-693 when I submit the whole package. No ?[/QUOTE]

Ok, here we go.

1. Since you don't have any records of immunizations, get a titer lab report. By running titers, they will be able to determine what immunizations you've had or what you do not need.
2. They won't know what to tests to include in the titer lab report UNLESS you tell them. Just bring the I-693 and show them what you need.
3. If the titer lab report, comes back showing you're immune to everything, then you don't need any shots. Follow me here?
4. The IGRAs - if you have had the BCG vaccine, you will get a false positive with the skin test. The prefer method is a blood test. (I explained it all on my previous entry)
5. You can submit the I-693 now and shorten its validity from 2 years to 1 year. IF that's what you want to do, then go for it. I also already explained why you should wait - courtesy letter - bring it to interview.

I think you should read the instructions. It's all there. Slow down and read them. I see you asking smiley whether the TB test was a titer test. Slow down. Read what I diligently wrote for you. Digest it. OR you could just read the instructions because it's all there.

[UScitizenFilingforspouse]

That list is mostly the recommended vaccines that most Americans receive. You could pull out Hep A (most don't get the Hep A vaccine). I'm not sure what gono is.

If you've had chickenpox before, you may have a positive varicella titer and not require immunization. Of course, talk it over with your health provider since I'm just an annonymous person on the internet.

A TB skin test is when they inject a small amount of liquid just under the skin. You must return in 48 to 72 hours for the nurse to determine whether there was a reaction. If you've ever been exposed to TB in your life, it will be positive whether you got sick or not. A chest xray is then used to identify whether there is an active infection. The results of the TB skin test are usually only good for a year. I'm fuzzy on the specifics on whether USCIS will take an old TB skin test.

You should be able to get many of the vaccines free/low cost through the student health center or your county health unit. Also, your insurance will likely cover the vaccinations as part of a annual wellness exam by a regular doctor or nurse practitioner (separate from the immigration medical exam). Then just bring the documentation to the civil surgeon and they can fill out the paper with that. Just remember, if you had the shots in another country, they would accept that documentation. It's no different if you get them somewhere here.

He's had the BCG vaccine and that will cause a false positive TB skin test. In his case, *as I explained to him*, he needs one of 3 IGRAs the CDC recognizes for immigration purposes - *as outlined on the instructions*. Exposure to the BCG vaccine will not cause a false positive result with a IGRA.
He's an adult. It's not recommended to just give shots to someone who doesn't know what they've had. You run titers (levels/concentrations) and then determine what is still appropriate to administer.