'There are bound to be loopholes': Americans may face surprise bills with COVID-19 vaccination

Although there are rules in place to protect Americans from paying anything out-of-pocket for a COVID-19 vaccine, consumer advocates fear that patients still may face surprise vaccine bills, according to The New York Times. 

This spring, Congress passed legislation to prevent insurers from applying member cost-sharing, which includes copays, deductibles and coinsurance, to costs associated with coronavirus vaccinations. It also tacked on rules barring pharmacies, physicians and hospitals from billing patients for vaccine administration. 

The increased protections around vaccine administration costs are unique in that there are requirements on both the insurers and providers, according to the Times.

However, consumer advocates say that suprise vaccine bills may end up in patients' hands, just like they did with COVID-19 testing and treatment earlier this year. 

"It is the American healthcare system, so there are bound to be loopholes we can’t anticipate right now," Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, told the Times. 

Americans vaccinated this year and early next year won't be on the hook for the vaccine itself, because the federal government is purchasing the doses for them. Currently, the federal government has purchased 100 million doses from Pfizer and plans to purchase up to 200 million from Moderna, pending FDA approval. 

Even with increased consumer protections, consumer advocates see ways patients may end up with bills, including "grandfathered" health insurance plans that were established before the ACA and not required to cover preventive services like the coronavirus vaccine. 

Additionally, experts are worried about uninsured Americans. There is no national program that will cover their vaccination costs. Instead, the federal government said health providers should submit applications for vaccine cost reimbursement to HHS, which will come from the $175 billion Provider Relief Fund. 

The Times also reports that more fees may be associated with vaccine administration. In particular, some providers charge a visit fee for in-person appointments. The laws passed by Congress this spring do not address whether this fee can be billed to patients. 

"The question that I'm still not clear on is what happens if someone walks into an outpatient department that charges a facility fee and gets a vaccine,"  Kao-Ping Chua, MD, PhD, an assistant professor of pediatrics at the University of Michigan in Ann Arbor, told the Times. "Is there a possibility they could get charged? I think the answer is yes."

Read the full article here.

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