If the insurance company denies the claim, it just gets lumped in with the group reimbursement from the federal gov’t.
We have thought about this too: our son is 11. Walmart explicitly says they don’t check your eligibility, but asks you to attest that you are eligible (or something similar, just remember reading it and being pretty sure we could do it if we were willing to lie). Ultimately decided against it.
My friend got his 13 year old vaccinated before they lowered the age by claiming she was 16. He had a bit of a hard time, but probably because she is short, and in no way looked 16.
In my neck of the woods, the vaccine is completely free. If you have insurance they bill your insurance, if you don’t they bill the state. I don’t want to encourage unethical advice but understand wanting your kid to be protected. You could just claim to not have insurance.
Just to be clear, they are billing for administering the vaccine. The Feds are providing the vaccine free of charge for everyone everywhere.
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Thanks, I actually didn’t know that!
Interestingly, Walmart never billed my insurance for my 2nd shot. They did for my first shot. I wonder if the pharm tech just checked me in as uninsured for my 2nd shot. Oh well. Somebody paid my admin fee.
Also, I wonder if Blue Cross thinks I only had one shot.
That is interesting.
How long has it been? Is it possible that it’s still outstanding?
Is it possible that the first fee covered both shots? Sort of like how a lot of bridge tolls and the Staten Island Ferry fare are all double-or-nothing?
Any US-based health actuaries know?
I could see it being a lot less administrative burden to have one fee for both shots. If you scheduled your second shot when you got the first then it might be cheaper for the insurer to just pay Wal-Mart both fees and accept that they’ll lose a little due to no-shows than pay a claims analyst to deal with almost twice as many Covid shot claims.
If it’s just the administration of the shot it can’t be that much, can it?
Like let’s say it costs $5 to deal with a claim and 98% of the ones who get the first shot of Pfizer or Moderna and schedule the second shot will actually show up for the second shot at some point (even if they miss an appointment or two but they eventually get it) and their negotiated rate with Wal-Mart is $20 per shot.
If they pay $40 the first time then their average cost per person is $45.
If they pay $20 the first time and $20 the second time then their average cost is $25 + .98 * $25 = $49.50.
Cheaper to just assume everyone will show up.
And since it helps Wal-Mart out too (because it also costs them $5 per insurance claim), they might be willing to accept $38 or $39 for both shots payable after the first one.
I have no idea how close my numbers are, but it seems like they could be trying to reduce the overall number of claims by doing something like that.
Also, since trained claims analysts don’t grow on trees, and they’re also dealing with Covid hospitalization claims, the claims teams might be severely overworked to the point that even if the savings was negative it might still be worth it to double up the first time.
Lots of people went to different places for their second shot, although that was discouraged. My guess would be a lazy clerk found it easier to check, “no insurance info”. But maybe someone in health knows for sure.
Feds pay for the serum. Insurance companies are on the hook for the administration for commercial plans (for Medicare the admin is paid by the govt).
Cost for the administration was $17 for the 1st shot and $28 for the 2nd/single shot (so $45 for a 2 shot regimen). In mid-March CMS changed the admin rate to $40 for each of 1st/2nd/single ($80 for a 2 shot regimen).
The shot can be billed as either a medical claim (you got the shot at your doctor office) or a pharmacy claim (you got the shot at a CVS/Walgreens/etc.) If it is billed as a medical claim, then the cost to the insurance company is probably > $40 since most contracted rates for commercial insurance pay > 100% of Medicare (if the contracted rate is 150% of Medicare then it would be $60/shot). If billed as a pharmacy claim, then it will pay out at 100% of Medicare (so $40).
In most cases if you got the shot at a state/community vax site, you insurance company will not be billed. If you got the shot at a clinic, CVS, Walgreens, etc then it more than likely gets billed to your insurance company. But as stated above, that is not always happening.
Unless insurance companies can tap into state registries (which I don’t think they can right now), if your shots were not billed to them they will not know if you were vaxxed or not.
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For the sake of pedantry… the feds are not providing the vaccine for “free”. We’re paying for it either with our tax dollars, or by the erosion of our currency by printing up more money (depending on your perspective).
What I’m really going to be curious about is where things settle when it comes to the expense of COVID testing. Today, the default seems to be to test with no out-of-pocket expense to the patient. However, as I look towards restarting my regular trips across the US/Canadian border, I’ve started wondering about the expense of obtaining the prerequisite clean test results. I won’t be taking such tests for “medical necessity”, after all.
Presumably government officials will cover the tests with taxpayer/deficit funding for a while in the interest of public health, but eventually…?
Tests for travel have been at the expense of the traveler for as long as i can recall. Many of my friends have compared the price, speed, and convenience of different providers.
Well I did specify that they made the appointment at the time they received the first shot, and I estimated 2% of folks who make the appointment for the second shot never show at that location. You think 2% is too low among the subset who actually scheduled a second shot at the same place as their first? What percentage do you think is accurate?
Wow… that’s quite a difference. I guess the feds want to encourage the providers to encourage that people get their second dose?
Yes, my statement was meant as “the feds are buying the vaccine and then shipping it to the states/providers with no payment required from those states/providers.” There’s no such thing as a free lunch.
Also, the stock of the producers of the vaccines have done well since so many countries are ordering and paying for so many billions of doses.
I have no guess. I just thought it was implausible that the full cost of both vaccines was charged for the first visit. In part because people might switch locations.
And it seems i was right.
Ok that makes sense. I just looked at the EOBs for my family. We had our vaccines administered in 4 different places. The amounts are all over the place between $16.94 (for two of the “1st shots”) to $40. My youngest, who wasn’t eligible until after the rest of us, was $40 per shot.