Every fall, a multitude of commercials from companies offering free flu shots start flooding the airwaves. Each year, millions of people take advantage of these offers in the name of protecting their health for another year. What many of these people do not realize is that these “free” flu shots aren’t really free and they may end up paying for them another way.
An investigation by Kaiser Health News found that some providers have forced insurers to pay upward of three times the price they would pay for the same flu shot to other providers. The investigation found that insurer Cigna paid $32 for a shot in downtown Washington, DC; $40 for the same shot 10 miles away in Maryland; and $47.53for that shot at a doctor in Long Beach, California. One doctors’ office in Sacramento, California got an insurer to pay $85 for a flu shot that it offered to uninsured patients for $25.
The prices found by the investigation are significantly higher than federally negotiated rates. The Centers for Medicare and Medicaid Services pays providers $18 for the vaccine. The Centers for Disease Control and Prevention negotiated a price just under $14 for the same shot.
Health insurance companies pay wildly different amounts for the same vaccines. The prices ultimately depend on how negotiations go with individual medical providers across the country. This means that the price of a flu shot is based solely on whatever deal the insurance company and the provider have struck, not the actual cost of the vaccine.
Hidden negotiated rates make it impossible for patients to know the price before they get the shot. The Affordable Care Act requires insurers to cover the full costs of all federally recommended vaccines. The clinic cannot charge a copay, deductible, or coinsurance for flu shots, so in many cases, the patient gets no bill.
The pricing of flu shots are a prime example of how the health care system’s lack of transparency can lead to some paying much more for the same health care as others. The price discrepancies quickly add up as tens of millions of people receive a flu shot each year. The extra costs to insurers get passed on to patients through higher insurance premiums.