How to get paid if a patient’s health plan doesn’t cover the COVID-19 shot

Physicians can now request payment for administering the COVID-19 vaccine to patients whose insurance doesn’t cover it. While most health plans are required to cover the cost of administering the COVID-19 vaccine without cost-sharing, there are a few exceptions (such as grandfathered group health plans and short-term individual plans).

In the rare event that health plans do not cover vaccine administration, practices are prohibited from balance billing patients for it. Until recently, this left practices in a tough spot, because the Health Resources and Services Administration (HRSA) only provided payment for uninsured patients. But now HRSA has announced a Coverage Assistance Fund (CAF) to provide payment for patients whose health plan doesn’t cover the vaccine administration, or covers it but imposes cost-sharing.

To apply for payment through the CAF, physicians must first submit a claim to the patient’s insurance plan. If the claim is denied or only partially paid, physicians can then submit a claim to the CAF Portal to receive payment. The CAF will provide payment at the Medicare rate.

Additional information is available on the HRSA’s CAF website, including:

• CAF Program Fact Sheet
• Frequently Asked Questions
• Educational Toolkit
• Clearinghouse Fact Sheet
• Provider Portal Guide

Practices can also still request payment for administering the COVID-19 vaccine to uninsured patients through the HRSA Uninsured Program.

— Erin Solis, Manager, Practice & Payment at the American Academy of Family Physicians