Annual flu shots that are free for those with health insurance are not immune to the confused and contemptuous pricing that has plagued the US health care system.
Health insurance companies pay wildly different amounts for the same vaccines, depending on how negotiations are conducted with individual healthcare providers nationwide. In some cases, providers have forced insurers to pay three times the price they would pay to other providers, according to an investigation by Kaiser Health News.
The output notes that a doctor's office in Sacramento, California, has an insurer to pay $ 85 for the flu it offers to uninsured patients for $ 25.
Although $ 85 may seem like a triple sum in the bloated scheme of the US health care system, such prices are quickly adding up as tens of millions of people get the flu shot every year. And while the Affordable Care Act requires insurers to cover the full cost of all recommended federal vaccines, including the flu vaccine, all additional costs for insurers are passed on to patients through higher insurance premiums, economists told KHN.
Looking further at what insurers paid for flu vaccines, KHN found that the costs covered the entire range of $ 25- $ 85. A doctor in Long Beach, California, made Cigna insurer pay $ 47.53 a picture, while CVS in downtown Washington, USA received $ 32 from Cigna for the same shot. CVS just 1
My insurance got a little better than this. My doctor's office in the District of Columbia initially charged my insurer Aetna $ 35 for my flu shot, and Aetna paid them the agreed rate of $ 24.50.
But this is still significantly above federal tariffs. The Centers for Disease Control and Prevention negotiated a price just under $ 14 for the same frame. The agency reported costs to the private sector of about $ 18. Similarly, the Centers for Medicare and Medicaid Services pay $ 18 for the vaccine.
Aetna paid about 35% more than my identical shot – and I couldn't figure it out before I did. Hidden bargaining rates make it impossible for patients to shop. And it's not just a problem for the flu. Wild price differences are common to everything from diagnostic scans to surgery.
"We do not have a functioning healthcare market because of all this lack of transparency and opportunities for price discrimination," Glenn Melnick, a health economist at the University of Southern California, told KHN. "Prices are inconsistent and confusing for consumers," he added. "The system does not work to provide efficient care and the flu shot is an example of how these problems continue."