UnitedHealthcare will reimburse providers for COVID-19 vaccine underpayments

COVID-19 vaccine
UnitedHealthcare is reprocessing "millions" of claims for COVID-19 vaccines. (Getty/Hector Pertuz)

UnitedHealthcare will adjust claims for COVID-19 vaccines in response to providers who said they were paid sub-Medicare rates to administer the shots.

On its website, the nation's largest insurer said it has been reimbursing for COVID-19 vaccines at the $40 per administration Medicare rate since July 1 but that it will adjust claims that were underpaid between March 15 and June 30 to that same rate.

"We understand the importance of reimbursement to providers and the effect it has on ensuring they are able to provide vaccinations," UnitedHealthcare said on its website.

A number of physicians, particularly pediatricians, have called out UHC for underpaying them to administer COVID-19 vaccines. In an interview with Fierce Healthcare, George Rogu, M.D., a pediatrician and CEO of Commack, New York-based RBK Pediatricians, said physicians of all kinds faced significant costs in setting up vaccine programs.

RELATED: Biden admin to boost Medicare reimbursement for COVID-19 vaccinations

"Physicians, private offices and such, they went through hoops to be able to administer the COVID vaccine," Rogu said.

And while none of the available vaccines have yet been approved in children under 12, Rogu said pediatricians played a key role in vaccine outreach and were administering those shots to teenage patients as well as family members.

Physicians like Rogu have been making noise on these reimbursements for several weeks, leading legislators to take a second look at the practices. Pennsylvania Senator Bob Casey, a Democrat, sent a letter to UnitedHealth Group CEO Andrew Witty urging the company to review its claims process to expeditiously reimburse providers and avoid future pay cuts.

The letter (PDF) was first obtained by Modern Healthcare, which broke the initial story.

According to Casey's office, UnitedHealth executives confirmed for legislators during September calls that they were paying some providers below Medicare rates to administer vaccines and that these claims would be reprocessed automatically. 

UnitedHealth execs said they would need to reprocess "millions" of claims, according to the letter.

"While other major payers reportedly adopted the reimbursement rate set by CMS swiftly, UnitedHealth continued reimbursing at a lower rate until the end of June. During conversations with staff, UnitedHealth reported that it had problems uploading the CMS rate to the company’s various fee schedules," Casey's office said in the letter. 

"Aging Committee staff have heard concerns from providers that the reimbursement issues pediatricians experienced with UnitedHealth earlier this year could resurface when the FDA authorizes a COVID-19 vaccine for 5-11 year-olds, which will carry a different billing code," Casey's office said.