Underpayment of Covid vaccines has been a cause of distress for providers administering the shots. The issue first surfaced when Canid found a pattern of low reimbursements for Covid vaccines by UnitedHealth Group (UHG) for our client. This pattern was subsequently confirmed by many pediatricians and raised red flags across the country. We believed it was of utmost importance that we fight for our pediatricians and our efforts alongside those of the AAP led us to a fruitful victory. As a result UnitedHealth Group has agreed to repay those pediatricians that it had been short-changing since March of 2021.
The issue was first discovered when we (Canid), as an all encompassing vaccine management program, noticed some discrepancies in reimbursements by UnitedHealthcare (UHC) for the Covid Vaccines. While analyzing the billing and reimbursements for our client, RBK Pediatrics, we noticed that the insurance giant had been consistently paying significantly below Medicaid for COVID vaccine administrations.
On March 15, 2021 the Centers for Medicare and Medicaid Services (CMS) increased its Medicare reimbursement for administering the Covid vaccine to $40. The federal government also required that private plans have reimbursement rates that are ‘reasonable, as compared to prevailing market rates’. UnitedHealth Group had been paying its physicians less than market rates which were approximately 50% of those set by CMS.
In such unprecedented times, the insurance giant has been unreasonable with its reimbursement and gave no support to providers raising this issue. This is not the first time UHG has been under fire for shortchanging providers. Similar reports emerged when physicians flagged that the insurance company was paying lower rates for COVID-19 tests. The low fees left many doctors with no choice but to stop offering these services, which has been difficult in the face of a pandemic. During this time, Dr. Rogu, CEO of RBK Pediatrics, had also pointed out that practices with a large portion of patients with UHC insurance suffer from this type of under-reimbursement.
Canid and Dr. Rogu decided to go to the wider pediatric community at the AAP, and was able to confirm that at least 25 independent pediatric practices, which included more than 350 providers across the country, had been paid below the federal rate by UHC.
We, as a start-up, pride ourselves in not only being a detail oriented and well-rounded vaccine management program, but also an ally of independent pediatricians. To advocate for pediatricians, our team at HQ worked tirelessly to reach out to countless health reporters across the country so we could shed light on this issue. We worked alongside many people that stepped up to escalate this issue and made it a priority to talk to health reporters and speak on their perspective. Among many were Dr Rogu, CEO of RBK Pediatrics, Dr. Susan Sirota of PediaTrust, Dr Susan Kressly who works on Insurance issues at the AAP, Dr. Peter Pogacar, VP of the Rhode Island Chapter of the AAP and Dr Brad Fell of Allied Physicians Group. Our goal was to bring media attention so that we could alert other pediatricians that may not have noticed and to hold UHG accountable. The story was also successfully published on well known media platforms such as Modern Healthcare and Insider.
On October 21, 2021 after weeks of follow-up and advocacy on behalf of pediatricians across the country, we received the good news that UHC has agreed to reprocess any claims that were less than $40 per administration between March 15 and June 30, 2021. Providers do not have to take any action to be credited for these immunizations and the insurance provider has projected to adjust all claims in the coming few weeks.
Collaborative efforts by pediatricians, AAP and Canid have successfully earned thousands of pediatricians, across the US, millions of dollars in unfairly paid vaccines. While our company may be small, we worked efficiently and effectively to prove that our willingness to support our pediatricians goes a long way.
The ability and commitment to advocate on behalf of independent pediatricians is what sets us apart from other vaccine management programs. As a company we value going the extra mile to ensure that pediatricians and their offices can fully commit to the care of their patients without worrying about logistical issues. It can be particularly time and resource expensive for independent practices to take on an insurance conglomerate such as UnitedHealth Group. As a result independent pediatricians often lose out, but with Canid at their side they don’t have to anymore. In a time like this it is important to support our front line workers and do our part to help them where we can. If you want to learn more about what Canid can do to support your practice, Contact Us
