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Curious - how is your Covid vax being paid for?


SKL
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Walgreens is advertising "free" Covid vaxes, but they ask for insurance info, and sure enough, I got an EOB for my kids' vaxes.

I wasn't asked for insurance info nor money at the mass vax site where I got mine.

I assume they aren't turning anyone away or making them pay cash, am I right?  Who's paying for what, and how?  Does anyone know?

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My understanding is that they bill your insurance, and if you aren't insured or don't provide insurance information, then the federal government reimburses.  I'd rather my insurance paid than the tax payer so I was happy to provide the info.  But, I'm also glad there is an option for everyone. 

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We got ours at a pharmacy and it was billed to our health insurance. Our provider, United Healthcare, said the entire cost of both doses would be covered, with $0 cost-sharing (so no co-payments, deductibles, or coinsurance) and that we would not be billed by the pharmacy or by United Healthcare.

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My husband was vaccinated at the health dept and wasn't asked for any insurance info.  

I was vaccinated at a mass vaccine site and wasn't asked for any insurance info.

Our youngest was vaccinated at the hospital where she has been a patient so they had our insurance.  For that one our insurance paid about 1/2 of what was billed and we were not charged anything.  I didn't even get an EOB for it, but did see it entered on the insurance portal.  The same amount was paid for each of her 2 doses.

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I kind of assumed it was being paid for by federal stimulus money, but I really have no idea. The three of us here (me, DH, DS22) got ours through our county health department and they didn't ask for any insurance info.

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I went to a mass vax site.  The form had a place to fill in insurance info, but I left it blank so I imagine it went to the government tab.  Dh was vaccinated at a workplace event, which was paid for directly by his employer.

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Mass vaccine site run by the county: they said that I could optionally provide my insurance information so that they could bill them for the administration charges involved but the actual vaccine itself was paid for by the county and was free. My state does not charge for vaccination for those who don't have insurance (and people without legal immigration status). I provided my insurance information.

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1 hour ago, SKL said:

Walgreens is advertising "free" Covid vaxes, but they ask for insurance info, and sure enough, I got an EOB for my kids' vaxes.

I wasn't asked for insurance info nor money at the mass vax site where I got mine.

I assume they aren't turning anyone away or making them pay cash, am I right?  Who's paying for what, and how?  Does anyone know?

So, this was actually explained in great detail to us, because we got ours through CVS, but they had some weird glitch in their system and it showed that DH was uninsured (but everyone else was insured, which is, you know, impossible when he's the primary....). Anyway, in sorting it all out, what they told us was:

The gov't is paying for the vaccines, period. But, if you have insurance, they first bill insurance, who pays them, and then the gov't pays the insurance company (this is easier/streamlines it for the actual providers and lets them get their money faster). If you don't have insurance, you are not billed at all, and it's totally fine, and the gov't pays for it.  BUT, they have to submit it under the right circumstance, because if they first send it off as "uninsured" when you really do have insurance, apparently that can mess things up somehow or another and it will get rejected/delay them getting their money even more, because first the gov't will say, no, this person has insurance, and want it to go through them (even though the gov't will then reimburse the insurance). Presumably so it doesn't end up double-dipping or something. 

In any case, they still vaccinated DH and never did ask for us to resubmit his insurance info or anything. 

I also know folks who've gone to get it who are uninsured; no problems at all. 

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The vaccine is 100% free to the recipient no matter what. The government pays for the vaccine itself, but whoever gives the shot can charge a fee for administering it, which insurance companies are required to cover, with $0 required of the patient, regardless of whether they've met their deductible, would normally have a copay, etc. 

I provided insurance info to the pharmacy where I got my shots, but haven't seen any statement from insurance so far. DD got her shots at a mass vax site run by the health dept, and I just got an EOB for her first shot, with $0 owed. DS got his shots on campus through his university health portal, and he has the student insurance, so I assume they are billing that.

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My understanding is the government (taxpayers) paid for the vaccines and that they are being distributed to providers at no charge.    The provider can charge an "administration fee" to cover the cost of administering the vaccine (but not for the vaccine itself); that administration fee is charged to the insurance company if the person is insured (not to the individual receiving the vaccine) and the federal government may be billed for the administration fee if the individual does not have insurance. 

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1 hour ago, SKL said:

Walgreens is advertising "free" Covid vaxes, but they ask for insurance info, and sure enough, I got an EOB for my kids' vaxes.

I wasn't asked for insurance info nor money at the mass vax site where I got mine.

I assume they aren't turning anyone away or making them pay cash, am I right?  Who's paying for what, and how?  Does anyone know?

I got mine 1st dose at walgreen's.  Asked for insurance, looked at the insurance card (I pay out of pocket until I hit my deductible), no credit card.

I believe they'll bill insurance, but my understanding is what insurance doesn't cover is paid by the state.    (though that might vary by state.)

 

Insurance companies have to cover more for kids than they do adults.

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RE: how much insurance companies will cover in terms of administration fees, Biden increased the Medicare reimbursement rate for administering covid vaccines from $28 for regular vaccines to $40 for a single covid shot, and from $45 for a regular two-shot series to $80 for two covid shots. It was suggested that private insurers could use that as an appropriate reimbursement rate as well, and that matches what my insurance company covered for DD's shot — they were billed $62 and paid $41.

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Frequently Asked Questions about COVID-19 Vaccination | CDC: The federal government is providing the vaccine free of charge to all people living in the United States, regardless of their immigration or health insurance status. and

 

COVID-19 vaccination providers can:

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We never saw a bill. They did copy our insurance card information, and I think ours was willing to.pay. But if they didn't pay or only a portion, the state kicked in because we have vaxed four out of five on our insurance and have never been billed.

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I bill vaccines for both a pharmacy and an affiliated mass vax site. If the patient doesn't put in the ins info, we search an online database that has a bulk of people in it. Honestly, even if people put in ins info, we usually check the database anyways and use that information. The database has very, very few errors unlike people who are trying to figure out what insurance information goes on which line, and common transcription errors (1, I and L can look alike, so do 2/z  0/O etc)  Like others have said, we bill private insurance first, then Medicare, then the uninsured Covid plan.  We do not want to get a thousand missbills, that we have to redo, so we take the time to check for insurance first.

We do want people to input their insurance on the form tho, because some people aren't in the database and then we have to take time to call them and try to get them to read us the information off thier card, which feels really, really sketchy for the patient!   And is difficult for us....people will say the ID# is four, oh, seven.....but is that really four, oh, seven or four, zero, seven etc. Letter and numbers are not interchangeable in the insurance world. 

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Our vaccines are purchased by the federal government and distributed in partnership with the provinces. Aside from logistics, there aren't any further costs after the initial mass purchase from the manufacturer.

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Dh, dss20 and I all signed up through the OK portal and insurance info was provided as requested.  Still no sign of an EOB and we all have had our 2nd dose for a full 4 weeks.  I will say that for dss20s second dose we had some major confusion with getting his appointment and I remember that I did not enter insurance info for that.  

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Posted (edited)
1 hour ago, bolt. said:

Our vaccines are purchased by the federal government and distributed in partnership with the provinces. Aside from logistics, there aren't any further costs after the initial mass purchase from the manufacturer.

Provincial health insurance plans are paying providers to administer it, similarly to payment for any other provincially covered health care service, so there definitely is additional cost borne by the provincial health insurance plans. (in Ontario, MDs are billing OHIP for each vaccine given in the office, or billing a sessional fee at mass vax clinics).  Though maybe that's what you meant by logistics?

ETA This is costing the provinces a whole lot of money (well spent, of course). I expect that provincial administration costs are greater than the cost of the vaccine themselves.

Edited by wathe
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2 hours ago, wathe said:

Provincial health insurance plans are paying providers to administer it, similarly to payment for any other provincially covered health care service, so there definitely is additional cost borne by the provincial health insurance plans. (in Ontario, MDs are billing OHIP for each vaccine given in the office, or billing a sessional fee at mass vax clinics).  Though maybe that's what you meant by logistics?

ETA This is costing the provinces a whole lot of money (well spent, of course). I expect that provincial administration costs are greater than the cost of the vaccine themselves.

That seems likely.

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