As COVID vaccines continue in high demand, some are wondering if the supposedly free shot actually comes with a cost.
Karen Adamski and her husband found a clinic through their Pinal County vaccine website.
They each got the vaccine and a surprise. About a month later, Adamski says she got her benefits statement from Medicare. "I nearly fell off my chair because I was totally shocked," she says.
The statement shows the MYDRNOW clinic charged Medicare $324 per vaccine. And Medicare only paid a very small part. The statement shows the couple could be billed up to $281 each.
"I didn't think we were going to be charged at all, " Adamski says.
So, if the vaccine is free, why this? Why would you need to provide insurance information?
It turns out vaccine administrators can seek reimbursement from some fees from insurers. But government rules call it "appropriate reimbursement" for administration from a plan that covers it.
As of mid-March, Medicare is paying just $40 per dose.
Adamski is worried. Before the couple received the statement, they went back to the same location for their second vaccine shot.
"Are we going to be charged another $281 dollars for the second visit? If so, my husband and I are looking at $1,200," she says.
The couple never received a bill from MYDRNOW. And government rules say that should not happen.
Providers must administer the vaccine at "no out-of-pocket cost" to the recipient.
And they may not charge an office visit or other fee "if the vaccine was the sole service provided."
So why go to Medicare with more than $600 for two vaccines? I didn't get that answer to that.
But in a statement, a MYDRNOW spokesperson says the couple will not be charged.
She says they have "not received an invoice for services rendered nor do they have an outstanding balance."
MYDRNOW says they "prohibit" billing patients for COVID vaccine costs that insurance doesn't pay.
They say they follow government guidelines with respect to all medical billing practices.
So, the couple won't be billed and hope it's the same for all of the others they say were going in and out getting their vaccines.
Rules also say no one can be denied a vaccine based on their coverage status and providers cannot require additional medical services in order for you to get the vaccine.
Here's the full statement from MYDRNOW":
Thank you for bringing this to our attention.
We had a chance to look into this matter and Mrs. Adamski & Mr. Bartoszek have not received an invoice from MY DR NOW for services rendered, nor do they have an outstanding balance related to the administration of the COVID-19 vaccine or any other service.
MY DR NOW follows CMS guidelines with respect to all medical billing practices, including but not limited to all types of vaccine administration.
CMS further determines the fee schedule and reimbursement rates for all medical services and we follow those guidelines in reporting services rendered.
MY DR NOW policy prohibits balance-billing patients for COVID-19 vaccine administration, and we are proactive in protecting all patients from any surprise billing.
MY DR NOW works tirelessly to fulfill its mission of providing affordable, accessible, quality healthcare and we hope we have cleared up any outstanding concerns."
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