How will a provider know if a child is underinsured?
Providers may not know a child is underinsured until they have billed the insurance and have been notified that the vaccine is not covered, unless they contact the insurance company prior to the visit. Providers may be able to look up the child’s benefit package online or call the insurer to determine their status as underinsured at the time of the visit. Health plan contact information for billing and coverage questions is available on the Department of Health Web site. It is important to note that the vaccine administration fee for the underinsured child is limited to the Centers for Medicare and Medicaid Services cap of $15.60.
Related Questions
- What if the child or their parents/guardians don’t know if the child is underinsured and the provider finds out only after the claim is submitted and payment is denied?
- If a child’s VFC status is underinsured, can the provider bill the child for the portion of the administration fee that the insurance won’t pay?
- How will a provider know if a child is underinsured?
