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?
This is a difficult question to answer. Since the child’s insurance policy does not cover vaccines, the insurance company most likely will not cover the administration of a vaccine. It is permissible to bill the child’s parent or guardian for the administration fee. However, the underinsured child can only be billed the maximum of the Centers for Medicare and Medicaid Services administration fee cap. Currently, the Washington State cap is $15.60. Q: If a health plan covers most vaccines, but not all, is the child underinsured for only the uncovered vaccines? For example, if a health plan covers all vaccines but HPV vaccine, can that child receive state-supplied HPV vaccine? (Added June 23) A: The patient is only considered underinsured for the vaccine (or vaccines) that are not covered by the health plan. Children with health insurance that does not cover HPV vaccine would be underinsured for HPV vaccine and eligible to receive state-supplied HPV vaccine.
Related Questions
- 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?
- Vaccine Administration Fees What are the statutory requirements for the VFC program regarding the vaccine administration fee?
- What if a patient is uninsured or underinsured and is not covered for the administration fee?
