Nov 16, 2021
UnitedHealthcare has said it will reprocess claims for COVID-19 vaccine administration after federal investigators found the insurer underpaid “millions” of providers — 40% less than the Medicare rate for administering the COVID -19 vaccine. Such low payments for vaccine administration could jeopardize patients’ access to these services and exacerbate the public health crisis.
While payers are not required by law to pay the recommended federal rate, UnitedHealthcare is the only state payer that had not agreed to pay at least $40 to administer vaccines.
UnitedHealthcare has added a note to its website stating that it “understands the importance of reimbursement to health care providers and the effect it has in ensuring they are able to provide vaccinations.” According to the payer, it will adjust claims paid under the Medicare rate from March 15 to June 30, 2021. The company says it will pay the $40 Medicare rate for vaccine administration since July 1, 2021.
“Rate changes are underway and claims will be adjusted in the coming weeks,” the UnitedHealthcare website reads. “Providers do not need to take any action to process these changes.”
“The ongoing effort to increase vaccination rates against COVID-19 across our country requires an all-people approach,” said a letter from Sen. Bob Casey, Jr. (D-Pa.), chairman of the special committee on aging, to Andrew Witty, CEO of the UnitedHealth Group. “Ensuring that all eligible children are vaccinated against COVID-19 is key to improving overall vaccination coverage, which will better protect older Americans by helping to contain the spread of the virus.”
In March, the Centers for Medicare and Medicaid Services nearly doubled what it paid for vaccine administration after the American Medical Association determined that the previous rate did not cover the cost of administering the injection. Federal law prohibits providers from billing patients for the COVID-19 vaccine.
UnitedHealthcare has also underpaid physicians for COVID-19 test kits, shifting financial responsibility for COVID-19 testing to physicians and making it financially unsustainable for practices to offer these tests to patients.
Ensuring doctors can administer tests and vaccines is critical to putting the COVID-19 pandemic behind us. This is why the California Medical Association (CMA) has sponsored legislation requiring health plans and insurers to cover COVID-19 testing and vaccinations during the pandemic without impediments such as patient-cost sharing or prior approval.
This bill — SB 510, written by Senator Richard Pan, MD — was signed into law and will ensure that all Californians, regardless of race, income or geographic region, can receive vaccinations and tests, which will remain necessary until the end of the pandemic. This bill also implements valuable lessons learned over the course of the pandemic by establishing a framework for preparing for future public health crises so that the state can be prepared for the next outbreak.
The new law will come into effect on January 1, 2022, but will be retroactive to the start of the public health emergency, which was declared on March 4, 2020.