A few weeks ago, we shared that after providers – namely, pediatricians – complained that the insurer was paying them substantially below market rate to administer COVID-19 vaccines, UnitedHealthcare agreed to reprocess its COVID-19 claims.
But now, reports from the California Medical Association say that another insurer – Anthem BlueCross – is reimbursing the new vaccine distributed to five- to 11-year-olds at less than 20% of the Centers for Medicare and Medicaid Services (CMS) rate of $40 per shot. That’s about $8 per shot. Which makes us wonder, would there be more vaccinations if claims were properly enforced – and properly reimbursed?
A study in the medical journal Pediatrics says yes. According to the data, “immunization and well-visit rates for infants, children, and adolescents were positively linked with physician reimbursement rates for those services.”
You don’t say.
This is a big issue for a big state like California, which is hoping to vaccinate 3.5 million newly eligible kids over the next couple of months.
But it’s a big deal for the other 49 states, too.
As mentioned above, we already know pediatricians in states “across the country” have criticized UnitedHealthcare for their low rates, so we’re not entirely confident that Anthem’s issues are unique to California.
It’s fortunate that children are less likely to die from COVID-19 than adults. But according to the Centers for Disease Control and Prevention, nearly 1,000 children under 18 have died from the virus. And far more have contracted the disease – nearly 6.2 million and counting.
Millions of parents and pediatricians want to protect kids from COVID-19 through vaccinations.
But can UnitedHealthcare and Anthem say the same?