Government Warns Doctors and Insurers: Don’t Bill for Covid Vaccines

The New York Times is investigating the costs associated with coronavirus testing, treatment and vaccination. You can read more about the project and submit your medical bills here.

The Biden administration is reminding doctors, hospitals, pharmacies and insurers that it is illegal to bill patients for coronavirus vaccines, a letter obtained by The Times shows.

The new warning responds to concerns among unvaccinated Americans that they could receive a bill with their shot. A recent Kaiser Family Foundation poll found that about a third of unvaccinated adults were unsure whether insurance covered the new vaccine.

“We recognize that there are costs associated with administering vaccines — from staff trainings to vaccine storage,” Xavier Becerra, the Health and Human Services secretary, wrote in a letter to vaccinators and insurers. “For these expenses, providers may not bill patients but can seek reimbursement through Medicare, Medicaid, private insurance or other applicable coverage.”

The letter warns that billing patients could lead to state or federal “enforcement actions,” but does not specify what the penalty would be.

The federal government wrote strong consumer protections to ensure that patients do not have to pay for coronavirus vaccines.

In stimulus legislation last spring, it barred insurers from charging patients co-payments or deductibles for the vaccines. The same law also created a fund that would cover the costs of vaccinating uninsured Americans.

Layered on top of those legislative protections are the contracts that doctors and hospitals signed to receive vaccines. Those documents specify that vaccinators cannot bill patients for the service.

The stronger protections appear to have worked. While many patients have encountered coronavirus bills for testing, there have been only a handful involving vaccines.

Still, the rules are not foolproof, and some patients have faced illegal charges. In April, the Health and Human Services office of the inspector general published a letter saying it was “aware of complaints by patients about charges by providers when getting their Covid-19 vaccines.”

A few patients have submitted bills showing surprise charges to a Times project collecting patient bills for testing, treatment and vaccination. The fees range from $20 to $850. If you received a bill for your coronavirus vaccine, you can submit it here.

Patients who receive bills for coronavirus vaccines can challenge the charge. Those with health insurance can reach out to their plan to ask why they received a bill when two federal laws — the Families First Coronavirus Response Act and the CARES Act — outlaw it.

A small subset of health plans is exempt from the laws. These “grandfathered” plans existed before the Affordable Care Act, and are not subject to requirements to fully cover the coronavirus vaccine or any other preventive service.

But even those patients are still protected by the contract that doctors signed barring any billing. The doctors can send the outstanding charges to a new Coverage Assistance Fund created by the Biden administration last month specifically to address patient coverage gaps.

Uninsured patients can direct their providers to bill the Covid-19 Uninsured Program, which was set up to cover those without coverage.

If an insurer or doctor is unwilling to reverse a bill, patients can seek help from state regulators. State departments of insurance typically deal with complaints about whether health plans are not appropriately covering medical care, while state attorneys general tend to field complaints about possible inappropriate bills from doctors and hospitals.