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I've certainly never encountered it before. And I am pretty sure, like you, that it is not supposed to happen. It wasn't the only squicky/skirting-the-law thing like that that happened in that place. I am so glad to be back in North Dakota!!
CPT Codes reported are:
99393 - Preventive service
90649 - HPV vaccine
90460 - Administration first component (1 unit)
90715 - Tdap vaccine
90460 - Administration first component (1 unit)
90461 - 2 additional components (2 units)
90660 - Influenza vaccine, live, for intranasal use
90460 - Administration first component (1 unit)
The first code is for the office visit and discussion of benefits and risks of the vaccine, and there is a separate code for each vaccine and for additional components of vaccines that contain more than one. Then there is an administration code for each injection. For vaccines with multiple components in one injection only one administration fee is charged. The administration fee covers the costs of such things as labor (the person who gives the vaccine), supplies used (such as when the vaccine does not come in a pre-filled syringe) and storage. Vaccine storage requires dedicated refrigeration with monitoring of temperatures, alarms, and a backup generator. It's expensive.
While the vaccine itself should be provided with no cost sharing, the administration fee may not be. Any questions about it need to be addressed to the insurance carrier as it will depend on your contract.
^^I am aware of coding, labor costs and the costs of maintaining a vaccine supply. However, it is my understanding that under the ACA, all of these are to be covered by the insurance with no charge to the patient at the time of service. There are some old "grandfathered" policies that don't have to follow these rules.
^^I am aware of coding, labor costs and the costs of maintaining a vaccine supply. However, it is my understanding that under the ACA, all of these are to be covered by the insurance with no charge to the patient at the time of service. There are some old "grandfathered" policies that don't have to follow these rules.
Can I just ask about 'contacting the insurance carrier'? Is this something that regularly occurs in the US? Do you not just go to the Doctors and then make the co-payment? Or do you have to check prior with the insurance company?
Can I just ask about 'contacting the insurance carrier'? Is this something that regularly occurs in the US? Do you not just go to the Doctors and then make the co-payment? Or do you have to check prior with the insurance company?
It's all sounding so foreign to me :-)
Sunflowers, American insurance can sound foreign even to Americans! It's a complicated mess, and a law passed a few years ago that was supposed to make insurance more affordable and allow more people to have it has instead made it more complicated - and more expensive.
One of the features of that law, which is often referred to as Obamacare, requires insurance companies to provide some preventive care, including vaccines, with no out of pocket cost to the patient. However, some companies may have the patient responsible for part of the cost of administering the vaccine which is separate from the cost of the vaccine itself. That is why the patient needs to know what his contract with the insurance company says about that fee.
It might help if we knew what your situation is. Are you immigrating or will you be here for a job, for example? If it is for employment, will you get health insurance through the employer? Do you know what the insurance carrier will be?
Normally there are several components to what you pay for insurance. First there is the monthly premium. If you have insurance through an employer, he may cover part of the premium as a feature of your job. Employers may offer several options with different premiums. Some of those options require that you use a certain panel of physicians; others let you see anyone who has signed up with the company to accept that carrier's insureds. Some plans are coupled with Health Savings Accounts that let you use pretax money to pay out of pocket medical expenses.
Then there will be a deductible. That is an amount that you must pay before the insurance kicks in, and since Obamacare was passed some people have ended up with very large deductibles. Larger deductibles usually come with lower monthly premiums.
Most plans also have a set copayment for each visit, unless that visit is totally preventive. For a child, that would be, for example, a well care visit for immunizations. Any problem discussed at that visit might generate a charge that would result in a copayment, so you have to be careful and clear about what a preventive visit is.
Some plans charge a coinsurance that is a percentage of the allowed charge rather than a set copayment.
Emergency Room visits and hospitalization have their own rules.
With any health insurance, you really need to read and understand the features of the policy, because there is no single standard policy for everyone. If you will be covered by an employer, someone in Human Resources should be able to help you. If you are on your own, you probably should consider using an broker to help you through the insurance swamp and protect you from possible alligators.
Can I just ask about 'contacting the insurance carrier'? Is this something that regularly occurs in the US? Do you not just go to the Doctors and then make the co-payment? Or do you have to check prior with the insurance company?
It's all sounding so foreign to me :-)
You can also contact the human resources people at your/your spouse's employer if they are providing the insurance. When I've needed help, I've found this works well. HR is getting paid to do all this "research" with the insurance companies. Let them do the legwork. Also, I think the insurance companies respond better to the HR people than individual subscribers.
For your specific problem, you can take your kids' vaccine records to the school/preschool where they will attending and they can tell you if the kids are up to date. I doubt there will be a problem; Australia's schedule is very similar to the US'.
I'll never understand why people will willing let chemicals like mercury and aluminum and anti-freeze and foreign human proteins to be injected into their children. people, just do a little research.
I'll never understand why people will willing let chemicals like mercury and aluminum and anti-freeze and foreign human proteins to be injected into their children. people, just do a little research.
People take vaccines because they prevent serious infectious diseases that can maim and kill people, mostly children. Because most people take them, you are protected from getting those diseases, too, even if you do not take vaccines yourself. It's called herd immunity.
You can also go to your local district health unit. They give vaccinations at a reduced price. When I was getting them for my children the price was $4.00 a shot but that was a few years ago.
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