November 16, 2021
UnitedHealthcare has said it will reprocess claims for COVID-19 vaccine administration after federal investigators found the insurer had underpaid “millions” of providers—paying 40% less than the Medicare rate for administering the COVID-19 vaccine. Such low payments for vaccine administration could threaten patient access to these services, and worsen the public health crisis.
While payors are not required by law to pay the recommended federal rate, UnitedHealthcare is the only national payor that had not agreed to pay at least $40 for vaccine administration.
UnitedHealthcare has added a note to its website saying it understands "the importance of reimbursement to providers and the effect it has on ensuring they are able to provide vaccinations." According to the payor, it will adjust claims paid below the Medicare rate from March 15 to June 30, 2021. The company says it has been paying the Medicare rate of $40 for administering vaccines since July 1, 2021.
"The rate changes are in progress and claims will be adjusted in the upcoming weeks," UnitedHealthcare's website reads. "Providers do not need to take any action for these adjustments to be processed."
"The ongoing effort to increase COVID-19 vaccination rates across our nation demands an all-hands-on-deck approach," according to a letter from Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, to UnitedHealth Group CEO Andrew Witty. "Ensuring that all eligible children are vaccinated against COVID-19 is key to improving the overall vaccination rate, which will better protect older Americans by helping stem the spread of the virus."
In March, the Centers for Medicare and Medicaid Services nearly doubled what it was paying for vaccine administration, after the American Medical Association found the previous rate did not cover the costs associated with administering the shot. Federal legislation bars providers from balance billing patients for the COVID-19 vaccine.
UnitedHealthcare has also underpaid physicians for COVID-19 testing kits, shifting the financial responsibility for COVID-19 testing to physicians and making it financially untenable for practices to offer these tests to patients.
Ensuring physicians can administer tests and vaccines is critical to putting the COVID-19 pandemic behind us. This is why the California Medical Association (CMA) sponsored legislation that requires health plans and insurers to cover COVID-19 testing and vaccinations during the pandemic without barriers like patient cost-sharing or prior authorizations.
This bill—SB 510, authored by Senator Richard Pan, M.D.—was signed into law and will ensure that all Californians, regardless of race, income or geographic region are able to receive vaccination and testing, which will remain necessary until the conclusion of the pandemic. This bill also implements valuable lessons learned over the course of the pandemic, setting up a framework in preparation for future public health crises so the state can be prepared for the next outbreak.
The new law takes effect January 1, 2022, but is retroactive to the beginning of the public health emergency, which was declared on March 4, 2020.