Some Republicans have likened the concept to invasive government surveillance

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In the United States, vaccine passports have become a controversial issue. But not everyone seems to be arguing about the same thing. The term “vaccine passport” generally refers to a smartphone app that can quickly confirm that someone has received a Covid-19 vaccine, so the phone’s owner can do things like enter a venue or board a plane. The debate over vaccine passports, however, often confuses these apps with the broader issue of how vaccination records are handled. Some Republicans have likened the concept to invasive government surveillance and even banned vaccine passports in some states, while vaccine passport proponents have argued that proof of inoculation could help businesses recover and push people’s lives closer to normal.

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It’s possible, if unlikely, that you might receive a bill or something that looks like a bill from your health insurance company anyway. This just happened to my colleague Sara Morrison, as she shared on Twitter. She had received an explanation of benefits from her insurer, Cigna, saying she owed 57 cents for her first dose of the vaccine. (She got another statement with a 96-cent balance after her second dose, she told me.)

That may sound like a trivial amount, but anything that creates any more confusion or hesitancy about getting the Covid-19 vaccine is an obstacle to ending the pandemic. Previous research has shown that even small out-of-pocket costs, as little as $10, can lead patients to postpone lifesaving medical treatment.

And it’s not just Sara: I searched Twitter for other reports of people who received a balance for the Covid-19 vaccine, and it wasn’t hard to find several examples. The Pennsylvania state insurance department, one of the most active in the country on consumer rights in health care, told me it had received complaints from patients about getting billed for the vaccine, and ProPublica has found patients who were billed.

Still, these are probably isolated incidents. But it’s important to be clear: They are mistakes. Congress has passed a law requiring that every American be provided the vaccine for free, no matter what health insurance they have or whether they have insurance at all.

“The rules for Covid-19 vaccines are clear: Vaccine providers are not allowed to bill patients, period,” Larry Levitt, executive vice president at the Kaiser Family Foundation, told me. “Everyone can get a vaccine for free, whether they’re insured or not.”

Some vaccination sites aren’t collecting any insurance information at all. (I went to one of them.) But other providers are asking patients for their insurance card when they show up for their vaccine appointment. And while searching Twitter, I came across people who were confused about why they were asked for their insurance card, some fearful they would get billed for their vaccine.

An intersection of two streets in Tulsa showing burned-out houses.
The providers can, legitimately, bill the insurer a small fee for the actual service of administering the vaccine. But that cost is supposed to be borne entirely by the insurance company. If you get a bill, or are confused by an explanation of benefits you receive, you should contact your insurer to let them know there may be a mistake. (Patients can also report any issues about insurance billing for the Covid-19 vaccine directly to the US health department.)

“Patients should not pay, and they should discuss any bill they think is an error with their insurer and provider,” Cynthia Cox, vice president at the Kaiser Family Foundation, says.

The one exception might be if a patient receives a vaccine during an appointment that they’d scheduled because they were sick or for another reason besides getting vaccinated. Normal charges for that sick visit could apply. But according to the Pennsylvania insurance department, “If the sole purpose of the visit is the receipt of the vaccine, the patient should not be billed.”

Cox and Levitt had a theory for why this might be happening: The provider might be coding the service in a way that indicates the patient should pay some of the cost. It may be, in other words, individual coding errors rather than something more systemic or nefarious. That matches the explanation I received from Cigna:

In rare instances where a customer does receive an EOB indicating they may owe a small amount for a COVID vaccine appointment, it is likely due to the appointment being coded incorrectly by the provider or an incorrect adjustment of a state administration surcharge by the insurer. If a customer believes a claim was processed incorrectly, we encourage them to reach out to us and we will review it.

But this is still a problem, because the US is at a critical moment in the pandemic. Right now, according to Bloomberg’s vaccine tracker, America has administered enough doses for 30 percent of the population. That is impressive progress compared to the rest of the world, but it is still well short of the 75 to 80 percent goal that public health leaders have set. And while more and more people say they will get the vaccine as soon as they can, there is still a sizable portion who say they want to wait and see.

For the Americans who say they will wait and see, learning that the Covid-19 vaccine is free can be persuasive in convincing them to get the shot, according to KFF’s polling.

Kaiser Family Foundation
The final stages of the US vaccination drive may require more persuasion because, so far, demand has been driven by high-risk populations, the people required to get the vaccine for work, and people who might be less at risk but were still eager to get the vaccine. As some places start to see demand dry up, public health efforts will have to do more to turn people out.

The promise of a free vaccine could be a powerful tool in that effort. But that requires Americans getting the message — and not being confused if they see stories of others who were mistakenly billed for their Covid-19 shot. The vaccine is free. End of story.

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