Authorities Warns Docs and Insurers: Don’t Invoice for Covid Vaccines

The New York Times is investigating the costs associated with coronavirus testing, treatment, and vaccination. You can read more about the project and submit your medical bills here.

The Biden government is reminding doctors, hospitals, pharmacies and insurers that it is illegal to bill patients for coronavirus vaccines, a letter received from The Times shows.

The new warning responds to concerns from unvaccinated Americans that they could get a bill with their shot. A recent survey by the Kaiser Family Foundation found that about a third of unvaccinated adults weren’t sure if insurance covered the new vaccine.

“We understand that there are costs associated with administering vaccines – from training staff to storing vaccines,” wrote Xavier Becerra, the health and social services secretary, in a letter to vaccinators and insurers. “Providers cannot bill patients for these expenses, but can request reimbursement through Medicare, Medicaid, private insurance, or other applicable coverage.”

The letter warns that billing patients could lead to state or federal “enforcement action” but does not specify what the penalty would be.

The federal government has written strong consumer protection to ensure patients don’t have to pay for coronavirus vaccines.

In the economic legislation last spring, insurers were prohibited from charging patients co-payments or deductibles for vaccines. The same law also created a fund that would cover the cost of vaccinating uninsured Americans.

Layered on top of these legal safeguards are the contracts doctors and hospitals have signed to get vaccines. These documents stipulate that vaccinations cannot charge patients for the service.

The stronger protection seems to have worked. While many patients have come across coronavirus bills for testing, only a handful have come with vaccines.

Still, the rules aren’t foolproof, and some patients have been illegally charged. In April, the Inspector General’s Office of Health and Human Services released a letter saying it was “aware of patient complaints about fees from providers to get their Covid-19 vaccines.”

Some patients have submitted bills with surprising fees for a Times project that collects patient bills for tests, treatments, and vaccinations. Fees range from $ 20 to $ 850. If you’ve received an invoice for your coronavirus vaccine, you can submit it here.

Patients who are billed for coronavirus vaccines can dispute the fee. Health insurers can turn to their plan to ask why they got a bill when two federal laws – the Families First Coronavirus Response Act and the CARES law – prohibit it.

A small part of health insurance is exempt from the law. These “grandfather” plans existed prior to the Affordable Care Act and are not subject to requirements to fully cover the coronavirus vaccine or other preventive services.

But these patients, too, are still protected by the contract that the doctors concluded, excluding any invoicing. Doctors can send the outstanding fees to a new Coverage Assistance Fund created by the Biden administration last month to fill gaps in patient care.

Uninsured patients can instruct their providers to bill for the uninsured Covid-19 program that was set up to cover those without insurance.

If an insurer or doctor is unwilling to withdraw a bill, patients can seek help from state regulators. State insurance departments typically handle complaints about whether health insurances are not adequately covering medical care, while attorneys general tend to file complaints about possible inappropriate bills from doctors and hospitals.

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