[Congressional Record Volume 168, Number 13 (Thursday, January 20, 2022)]
[Senate]
[Pages S375-S379]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
COVID-19 VACCINES
Mr. CASEY. Mr. President, as our Nation battles another wave of
COVID-19, I want to detail my efforts to lower barriers for Americans
to access lifesaving vaccinations against this terrible disease.
The Special Committee on Aging's investigation forced the largest
commercial health insurer in the United States to reverse course and
make whole providers who were paid far below the market rate for
administering COVID-19 vaccines. These efforts will help ensure that
every provider who can administer COVID-19 vaccines is doing so,
helping get more shots in arms.
Last year, news reports detailed how UnitedHealth had been
shortchanging pediatricians who were vaccinating children against
COVID-19. In short, Medicare set reimbursement rates for participating
providers at $40 per dose in mid-March 2021. The Federal Government
strongly recommended that private carriers do the same and most appear
to have done so within weeks, but UnitedHealth did not.
The committee's investigation found that UnitedHealth paid in-network
providers roughly 40 percent below the Medicare rate until July 1,
2021. Further, the company delayed action to make providers whole.
During the investigation, pediatricians in Pennsylvania and beyond
raised concerns that UnitedHealth's original reimbursement rate could
dissuade providers from administering the vaccine.
UnitedHealth covers 26 million people in employer and individual
market health insurance plans, with 1.4 million
[[Page S376]]
in-network providers and an estimated 14 percent market share.
UnitedHealth's decision to reimburse providers below the Medicare rate
had the potential to harm families across our Nation at a critical
juncture, just as the Food and Drug Administration prepared to expand
the availability of vaccines to children ages 5-11.
For parents with questions about vaccines, pediatricians are trusted
advisers who can play a key role in overcoming lingering concerns or
hesitancy, which remains a major issue in our Nation.
In the long term, ensuring that all hands are on deck to deliver
vaccines will help end this pandemic. Data has shown time and again
that being vaccinated against COVID-19 reduces infections, severe
disease, hospitalization, and death. Vaccinating children also will
help protect adults by increasing the number of Americans shielded from
the virus, reducing its spread. It also reduces the chance for the
virus to mutate and spawn variants, like Omicron, that has led to
another wave of illness and death. These concerns are particularly
important for older adults who are more likely than the general
population to experience both severe COVID-19 and breakthrough
infections. Vaccinating children helps protect older generations,
particularly older adults living in multigenerational households,
including more than 7 million grandparents who live with grandchildren
under the age of 18.
Providing more parents with the information they need to ensure they
are comfortable vaccinating their kids will help protect all of our
children. While pediatric hospitalizations remain relatively rare,
there has nonetheless been a significant increase of such
hospitalizations as the Omicron variant has spread in recent weeks. The
Wall Street Journal recently reported that pediatric hospitalizations
due to COVID-19 reached pandemic highs in the United States.
Vaccinating more children is essential to keep schools open for in-
person learning, a live issue for schools throughout our Nation that
have been forced to return to online classes in the face of the Omicron
variant. We must do all that we can to safely keep students in the
classroom so that they can receive the high-quality education they
deserve. School closures also cause a disruption in the lives of
families, with parents often struggling to find childcare or forcing
them to take time from work. Vaccinating children will help schools
remain open, protect students and educators, and help parents stay in
the workforce.
After Aging Committee investigators reached out to UnitedHealth, the
company quickly and voluntarily committed to change course, commitments
I detailed in an October 20, 2021, letter. In response to my letter,
UnitedHealth confirmed its plans to retroactively increase
reimbursements for approximately 2 million COVID-19 vaccine
administration claims to the Medicare rate across its entire commercial
network, including individual plans on the Affordable Care Act
marketplace. On January 14, 2022, the company reported that it had
processed 1.64 million claims in connection with its commitment to the
committee--more than 99.8 percent of the affected total--at an average
cost of $14.55 per claim for a total of $23.9 million. The company
expects the remaining claims, which number less than 2,900, to be
processed by February 1, 2022.
UnitedHealth also committed to more quickly update reimbursement
rates for future emergent vaccines and therapeutics, whether for COVID-
19 or the next pandemic. The company added that it is ``redirecting
additional internal resources and automating updates whenever
possible,'' while noting that their new processes still might involve
withholding claims ``for a short time,'' which it characterized as no
longer than 30 days. On January 14, the company went further, stating
that it will implement new billing codes in a national public health
emergency ``faster than industry standard,'' while noting that it has
``learned over the past few months the required technology and human
resources that need to be brought forward to accelerate'' adoption of
new billing codes in a public health emergency.
While lacking some details, the steps UnitedHealth has described
appear to be an appropriate response. However, UnitedHealth has not
adequately addressed an issue that a senior company official raised
when speaking with Aging Committee investigators in September, that the
company's size and numerous claims systems presented a barrier to
quickly updating COVID-19 vaccine reimbursement rates in the first
place. In its responses to subsequent questions about the issue from
committee staff, UnitedHealth has cited reasons such as contracting
language for the delay, but has failed to provide additional
information or explanation in their written responses. The fact that a
senior UnitedHealth official told the committee that the company's size
negatively affected the quality and efficiency of its interactions with
the market is concerning and a matter that deserves continued oversight
from Congress and regulators.
In recent weeks, the world has been upended by the Omicron variant.
Case rates have skyrocketed, and hospitals are once again filling up,
primarily with people who have not gotten a COVID-19 vaccine or
booster. In order to leave the tragedy, the disruptions and the
closures of the pandemic behind, every person who can be vaccinated has
a duty to the country to roll up their sleeves and get the shot.
We will continue to learn more about the Omicron variant and variants
to come. However, there is one thing about this variant, past variants,
and future variants that will not change: The key to ending this
pandemic is getting more people vaccinated.
I remain committed to removing future roadblocks that may emerge to
widespread vaccination against COVID-19.
This body should do the same.
In closing, I ask unanimous consent to have printed in the Record the
following documents: a September 3, 2021 Modern Healthcare article
detailing UnitedHealth's under reimbursement for COVID-19 vaccines
compared to most other major carriers; my October 20, 2021 letter to
UnitedHealth; UnitedHealth's November 5, 2021 response to my letter; a
November 12, 2021 supplement to the company's original response; and a
January 14, 2022 email from UnitedHealth providing further updates.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From Modern Healthcare, Sept. 3, 2021]
UnitedHealthcare Pays Providers Below Standard Rates for COVID-19
Vaccines
(By Nona Tepper)
Pediatricians across the country are claiming the nation's
largest insurer is shortchanging them for administering
COVID-19 vaccines, jeopardizing access to the main tool for
stopping the virus' spread.
The American Academy of Pediatrics has fielded complaints
from providers nationwide who are frustrated that
UnitedHealth Group is paying about 50% of the federal rate
for vaccine administration, said Dr. Sue Kressly, who chairs
the AAP's payment advocacy advisory committee and runs
Pennsylvania-based Kressly Pediatrics. While UnitedHealthcare
is not legally required to pay the federal rate, Kressly said
the Minnetonka, Minnesota-based insurer is the only national
carrier that has not agreed to pay at least $40 for vaccine
administration.
The insurer also continues to pay pediatricians and family
medicine providers below-market rates for COVID-19 tests,
Kressly said, an issue the New York Times revealed in
February.
With new variants of COVID-19 continuing to emerge, Kressly
worried that low fees for testing and vaccine administration
would lead some doctors to stop offering these services,
worsening the public health crisis, increasing medical costs
and inspiring more independent practices to shutter,
particularly as providers struggle with overwork during the
pandemic.
``They had record-breaking profits in 2020, and we
struggled with getting them to pay adequately for COVID
testing. That still not been resolved,'' Kressly said. ``Now
pediatricians who are giving the vaccine to people covered by
UnitedHealthcare, they're effectively opening their wallet,
and subsidizing that patient to get the vaccine.''
At the end of the company's most recent second quarter on
June 30, UnitedHealthcare generated $55.5 billion in revenue,
up 13% from the $49.1 billion reported during the same period
last year. The company counted more than 49.6 million
enrollees, an increase of 1.2 million year-over-year.
Meanwhile, the insurer's low vaccine reimbursement rates
threaten the future of family practices, Kressly said. Unlike
most medical services, federal legislation bars providers
from balance billing patients for the COV[0-19 vaccine.
``If we don't at least make enough money to cover our
costs, then we won't be here as practices to serve the
community beyond the
[[Page S377]]
public health emergency,'' Kressly said. ``That's a bigger
problem.''
UnitedHealthcare is not the only payer offering clinicians
low fees for vaccine administration--some regional plans and
employers are also paying below the federal rate, Kressly
said. But she said these payers are likely just slow to react
to payment standards. In March, the Centers for Medicare and
Medicaid Services nearly doubled what it was paying providers
for giving the vaccine, after the American Medical
Association found the previous rate did not cover the costs
associated with administering the shot. Most of these payers
are just confused about the update and, when Kressly reaches
out to them, she said they generally immediately increase
their rate. But UnitedHealthcare has refused to increase what
it is paying pediatricians.
``They say, `Our fee schedule is our fee schedule, it's up
to the contract that the practice has with UnitedHealthcare,
let them try to have the conversation,' '' Kressly said.
UnitedHealthcare, for its part, said it recently offered to
increase reimbursement for COVID-19 testing for some
pediatric and family medicine practices that met specific
criteria. When it comes to vaccines, UnitedHealthcare said it
is continually reviewing its reimbursement rates.
Dr. George Rogu, president of the Independent Pediatric
Collaborative of Long Island and head of RBK Pediatrics,
hopes to be one of the providers paid more for giving
UnitedHealthcare enrollees COVID-19 vaccines.
When Rogu reached out to the insurer last month. a
UnitedHealthcare customer service representative blamed his
low rates on his different customers' plans and the different
fee schedules associated with each. The customer service
representative said Rogu was the first provider to complain
about the matter and offered to refer his case to the
company's management team.
``We cannot in good conscience say, `Oh, we can't give you
the vaccine because you have UnitedHealthcare.' That's not
right,'' Rogu said. ``It's just not humanely right. But
people that have a large panel of UnitedHealthcare customers?
It's killing them.''
Rogu said he is still waiting to hear back from the
insurer.
He said he noticed that he was being paid below the federal
rates in May and asked New York-based Canid Vaccines, his
vaccine administration software system, about the problem.
The startup verified that UnitedHealthcare reimbursed him at
about half the rate that other insurers did. Canid Vaccines
said it has identified at least 25 independent practices
representing more than 350 providers nationwide that
UnitedHealthcare is paying at less than the federal rate.
Among pediatric circles, UnitedHealthcare is often referred
to as the ``evil empire'' since they are the least
transparent and least cooperative among the major insurers,
said Dr. Peter Pogacar, vice president of the Rhode Island
chapter of the AAP and a pediatrician at East Greenwich
Pediatrics. He said UnitedHealthcare is underpaying
physicians for COVID-19 vaccine administration there too.
``Healthcare should be about healing with business as a
sideshow, not the main event,'' Pogacar wrote in an email.
The insurer isn't just offering low rates for administering
the COVID-19 vaccine. UnitedHealthcare has also reimbursed
providers for less than what it cost them to purchase COVID-
19 testing kits. After significant media attention, the
manufacturer and distributor of the tests dropped their
prices so that providers were no longer losing money when
they were paid UnitedHealthcare rates, said Dr. Reshma
Chugani, a pediatrician at the Atlanta Children's Clinical
Center. The insurer also announced it would increase the rate
paid for the tests, as well as allow pediatricians to
resubmit patient claims, she said. But they are still not
offering to reimburse providers for tests previously paid at
below-market rates.
``We lost money on every United patient,'' Chugani said.
Additionally, the insurer has made it difficult for
providers to recoup the money it said it owes them, forcing
them to go through multiple administrative layers and still
failing to reimburse one type of test at the full rate, said
AAP's Kressly. She said she talked to UnitedHealthcare about
this issue two weeks ago and that it has still not been
resolved.
``They've put barriers for us to have to act when we have
no time, energy or resources to do so,'' she said.
____
October 20, 2021.
Sir Andrew Witty,
Chief Executive Officer,
UnitedHealth Group.
Dear Sir Andrew: I write in regard to commitments
UnitedHealth Group (UnitedHealth) made to the U.S. Senate
Special Committee on Aging related to reimbursement policies
for the administration of COVID-19 vaccines. UnitedHealth's
past policies appeared to have created access barriers for
children seeking COVID-19 vaccination from their primary care
pediatrician--barriers that affected younger and older
Americans alike. I appreciate the company's decision to
reprocess certain COVID-19 vaccine claims, which I expect
will facilitate the broadest possible access to COVID-19
vaccines among UnitedHealth's members. I expect that the
steps UnitedHealth has committed to take will help children
seeking COVID-19 vaccines as well as older Americans under
the purview of the Aging Committee, including the millions
who live with and care for their grandchildren or other
younger relatives. I appreciate your company's assurance that
UnitedHealth will keep the Aging Committee updated on its
progress toward expeditiously resolving the concerns raised
with the company.
The Aging Committee's attention was drawn to this issue by
press reports highlighting that during a four-month period
earlier this year, UnitedHealth reimbursed pediatricians at
rates that failed to meet the costs of administering COVID-19
vaccines. During that time, other large insurers reportedly
reimbursed pediatricians and other health care providers at a
higher rate, in line with what the Centers for Medicare &
Medicaid Services (CMS) set in March 2021. Pediatricians
raised concerns that UnitedHealth's low reimbursement rates
would deter in-network providers from administering COVID-19
vaccines, creating barriers for patients. The additional
costs of administering COVID-19 vaccines have been
significant for providers, a point that CMS noted at the time
it increased reimbursement rates, citing ``updated
information about the costs involved in administering the
COVID-19 vaccine for different types of providers and
suppliers and the additional resources you need to safely and
appropriately administer the vaccine.'' The agency
furthermore encouraged private payers to follow suit, noting
that ``in light of CMS's increased Medicare payment rates,
CMS will expect commercial carriers to continue to ensure
that their rates are reasonable in comparison to prevailing
market rates.'' Given UnitedHealth's status as the Nation's
largest commercial payer--with 26 million people enrolled in
employer and individual plans, 1.4 million in-network
providers and an estimated 14 percent market share--it is
critical that the company do all it can to ensure that
vaccines are available to every person that is eligible to
receive one. To that end, the Aging Committee requested that
UnitedHealth provide information about the company's
reimbursement rates, the timeliness of future fee schedule
updates and the company's progress toward making providers
whole for vaccines they administered while UnitedHealth was
reimbursing below reimbursement rates set by CMS.
The ongoing effort to increase COVID-19 vaccination rates
across our Nation demands an all-hands-on-deck approach.
Ensuring that all eligible children are vaccinated against
COVID-19 is key to improving the overall vaccination rate,
which will better protect older Americans by helping stem the
spread of the virus. Such efforts are of particular
importance ahead of the Food and Drug Administration's (FDA)
expected consideration of COVID-19 vaccines for young
children later this month. Older Americans have been among
those hit hardest by COVID-19 and face the greatest health
risks if they contract the disease, even after being
vaccinated. Recognizing the elevated risk of breakthrough
infections in older adults, the Biden administration recently
authorized third doses of the Pfizer-BioNTech vaccine for
people ages 65 and over. The serious health risks COVID-19
poses for older adults are especially acute for those living
in multi-generation households, including more than 7 million
grandparents who live with grandchildren under the age of 18.
Those older Americans are at even greater risk of exposure
when they live with unvaccinated individuals, an important
consideration given the greater impact of the delta variant
on children. The current wave of COVID-19 has led to higher
pediatric case rates, record pediatric hospitalizations and
school closures that have affected more than 900,000 students
at 1,800 schools across 44 states in August and September
alone.
During calls in September with Aging Committee staff,
UnitedHealth officials confirmed press accounts that reported
a months-long period when the company was reimbursing
providers up to 40 percent less for COVID-19 vaccine
administration than the rate set by the CMS. While other
major payers reportedly adopted the reimbursement rate set by
CMS swiftly, UnitedHealth continued reimbursing at a lower
rate until the end of June. During conversations with staff,
UnitedHealth reported that it had problems uploading the CMS
rate to the company's various fee schedules. Aging Committee
staff have heard concerns from providers that the
reimbursement issues pediatricians experienced with
UnitedHealth earlier this year could resurface when the FDA
authorizes a COVID-19 vaccine for 5-11 year-olds, which will
carry a different billing code.
Following the concerns raised by the Aging Committee last
month, UnitedHealth informed Aging Committee staff during a
call on October 6 that the company planned to address the
concerns outlined above. Specifically, UnitedHealth committed
to reprocessing all of its commercial claims--not just
pediatric claims--from the time CMS issued new rates for
COVID-19 vaccines in mid-March to the time United updated its
fee schedule on July 1. Company officials further stated that
United Health would reprocess the claims automatically and
that providers would not be required to resubmit claims for
reprocessing. Noting that the company expected to reprocess
``millions'' of claims that
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were submitted by providers during the three-and-a-half month
period prior to July 1, UnitedHealth officials told Aging
Committee staff that they hoped to make ``significant
progress'' within 30-45 days. Company officials further
committed to:
1. Review UnitedHealth's claims process to minimize delays
in making payments to providers for COVID-19 vaccines;
2. Verify that there are no similar underpayment issues in
its Affordable Care Act Exchange and Medicaid Managed Care
books of business: and
3. Provide updates to Aging Committee staff on the
company's progress toward meeting these goals.
As part of these updates, please also provide me with the
following information no later than November 5, 2021:
1. How many claims does UnitedHealth expect to reprocess
for COVID-19 vaccinations that were administered prior to
July 1, 2021? What was the average difference between the
initial reimbursement and the reprocessed claim? What was the
total amount that UnitedHealth paid to providers to settle
these claims at the CMS rates?
2. UnitedHealth told Aging Committee staff that it is
difficult to quickly update its reimbursement rates when new
vaccine billing codes and rates are issued by CMS.
UnitedHealth further stated that its expected solution for
this issue may involve delaying payments to providers to give
the company's payment systems time to reflect new codes and
rates. In order to minimize access delays in the future, what
steps is UnitedHealth taking to ensure that pediatricians and
other providers will be reimbursed in a timely manner when
CMS issues new rates for COVID-19 vaccines or other emergent
vaccines and therapeutics in the future?
Thank you for your attention to this important issue. If
you or your staff has questions, please contact Peter
Gartrell, Chief Investigator for Chairman Casey.
Sincerely,
Robert P. Casey, Jr.,
Chairman,
U.S. Senate Special Committee on Aging.
____
November 5, 2021.
Chairman Bob Casey,
U.S. Senate Special Committee on Aging,
Washington, DC.
Dear Chairman Casey: On behalf of UnitedHealth Group,
including our over 120,000 frontline doctors, nurses, and
other health care practitioners, thank you for your recent
letter regarding retroactive payment for COVID-19 vaccine
administration. Like many individuals and families,
clinicians and essential health workers have sacrificed
deeply these past two years as our country worked together to
fight COVID-19.
We share your commitment to ensuring and expanding access
to critically important health care services and understand
these are extraordinarily challenging times for the millions
of people we are privileged to serve, as well as employers,
health care providers, governments, and the health care
system. We welcome this opportunity to provide you with an
overview of the significant actions we have voluntarily taken
regarding vaccine reimbursement and the steps we are taking
to quickly address the concerns expressed.
UnitedHealth Group is committed to helping people live
healthier lives and making the health care system work better
for everyone. We do this by working with stakeholders and
partners to address the biggest challenges facing our system.
As we shared during our conversation, we have been in close
contact with the American Academy of Pediatrics regarding
concerns they raised about vaccine reimbursement.
Consistent with the discussion with your staff on October
6th and your October 21st letter, we are writing to confirm
the following details related to our reimbursement for COVID-
19 vaccine administration:
UnitedHealthcare (UHC) has been reimbursing providers using
the new CMS rates since July 1, 2021, consistent with timing
specified in UHC's contracts with providers.
UHC will adjust claims paid less than $40 between March 15
and June 30, 2021 to reimburse at $40 per administration, so
providers can benefit from the increase CMS announced on
March 15, 2021.
The voluntary retroactive reimbursement changes are in
process and claims will be adjusted accordingly. Providers
will not need to take action to receive the change in
reimbursement.
UnitedHealth Group recognizes the important role that
reimbursement plays in addressing the COVID-19 pandemic,
which is why we are taking action to adjust previous claims
and accelerating our processes to update reimbursement rates
when changes are announced by CMS. In your letter dated
October 21, 2021, you asked for the following information:
The number of COVID-19 vaccine administration claims UHC
expects to reprocess.
The average difference between the initial reimbursement
and the reprocessed claim.
The total amount that will be reimbursed.
Information on how we will ensure providers will be
reimbursed in a timely manner when CMS issues new rates for
COVID-19 vaccine claims going forward.
Approximately two million COVID-19 vaccine administration
claims paid between March 15 and June 30, 2021 will be
impacted by this retroactive adjustment. We anticipate the
average adjustment will be approximately $12.50 per claim,
for total additional reimbursement of approximately $25
million. UHC has already begun processing these
reimbursements.
With regard to new rates for COVID-19 vaccinations or other
emergent therapeutics for COVID-19, we will be accelerating
our process for updating our reimbursement to support the
COVID-19 vaccine codes and rates implemented by CMS as they
become available. Specifically, UHC will implement new COVID-
19 codes and rates upon the publication of this information
by CMS rather than including these changes in our scheduled
quarterly reimbursement update processes. This will ensure
provider payments are updated as quickly as possible.
We appreciate the services provided by health care
professionals during the pandemic. The actions we are taking
to adjust COVID-19 vaccine claims build on the many steps we
have taken to support providers over the last eighteen
months, including accelerating claims payments, assisting in
processing and administering CARES Act Federal funding to
providers, working with HHS to ensure clinicians who provided
COVID-19 testing or treatment for individuals without
insurance were reimbursed for their services, and removing
administrative requirements in highly impacted areas.
We appreciate the opportunity to address the Committee's
questions.
Sincerely,
Brian Thompson,
CEO, UnitedHealthcare.
____
November 12. 2021.
Addendum to UHG--Senate Aging Committee Response on 11/5/21
Thank you for the email of November 8, 2021 with follow-up
questions to UHG's letter dated 11/5/2021, and for your
continued engagement regarding how we reimburse providers for
COVID-19 vaccine administration. Please see our additional
responses below:
Staff asked that we clarify whether ``similar underpayment
issues occurred in United's Affordable Care Act and Medicaid
Managed Care plans.''
Answer: As discussed with staff, we have been paying
providers according to their contracts since the vaccines
first became available. These provider contracts explicitly
provide how new procedure codes are implemented and on what
timeline; those provisions are agreed to by all parties.
Because United paid its network providers according to these
contracts, there have been no ``underpayments.''
Nevertheless, after reviewing concerns about the contracted
reimbursement amounts paid earlier this year, we elected to
voluntarily increase reimbursement--above and beyond
contractual rates--for all commercial plans (including
individual plans purchased via ACA exchanges), for dates of
service between March 15, 2021 and June 30, 2021.
Within ACA Exchanges, we similarly have paid according to
contracts agreed to with providers. ACA Exchange plans will
be included in the voluntary increase in reimbursement
described above. The completion of that increase will be on
the same time frame as commercial plans. With respect to
managed Medicaid, as we noted in our first discussion with
staff on September 22, 2021, those plans pay according to
rates set by state law and state payment policies. United has
paid for vaccine administration consistent with those
parameters and will continue to do so.
Staff asked that we provide detail about how we will timely
reimburse providers for emergent vaccines and therapeutics
unrelated to COVID-19 and the current Public Health Emergency
(PHE).
Answer: In the event of a future pandemic or new PHE we
will take immediate actions (noted below) to accelerate
reimbursement updates. Outside of a pandemic or PHE how we
update codes and payment rates will continue to be guided by
our existing contracts with providers. Consistent with
industry practice, those contracts provide for timely and
substantial payment to providers while we complete the update
to our systems. At all times we will follow all applicable
state and federal requirements.
Staff noted the complexity of adjusting reimbursement rates
for new procedure codes and asked for details on how United
might make those adjustments more quickly in the future.
Answer: We hope that under less exigent circumstances CMS
will provide additional lead time for its pronouncements, but
United is not relying on that to speed its processes during
this PHE. Instead, we are devoting significant time and
effort to ensuring that the process of updating new COVID-19-
related codes within our systems begins at the time of
publication of those codes and without regard to contractual
timelines. This includes, for example, redirecting additional
internal resources and automating updates whenever possible.
While some claims filed immediately after new payment codes
are announced might be held for a short time while those
updates are being made (generally no longer than 30 days
after receipt), we believe this will result in overall faster
reimbursement at updated rates. Indeed, it is common in the
industry to hold claims during a period of change or
uncertainty to help ensure that those claims are paid
accurately. We are confident we will be able to update new
codes for all claims platforms on a timely basis.
Finally, staff asked for updates as to our progress on
increasing the reimbursement amount for the approximately two
million claims impacted by our decision to voluntarily
increase reimbursement for COVID-19 vaccine administration.
Answer: To date, we have resolved approximately 60% of
these claims. We expect the
[[Page S379]]
remaining claims to be completed in the coming 6-8 weeks. We
will update you when all claims are complete.
____
From: Prible, John M.
To: Gartrell, Peter (Aging)
Cc: Hartman, Doug (Aging); Shakow, Peter
Subject: RE: Follow Up on UnitedHealthcare's Response
Date: Friday, January 14, 2022 5:12:29 PM
Peter, thank you for your recent email, in which you asked
for an update on our voluntary efforts to retroactively
increase reimbursement to $40 for COVID-19 vaccine
administration. Answers to your questions are provided below;
however, we expect that this confidential information will
not be shared with third parties.
To date, we have retroactively reimbursed providers for
1,640,996 claims, or more than 99.8% of all affected claims.
The average additional payment for those claims was $14.55,
for a total of approximately $23.9 million in additional
payments. At this time, fewer than 2,900 claims (less than
0.2% percent of all affected claims) remain to be
reprocessed. Because the original paid amount on those
remaining claims averaged about $36, the average additional
reimbursement to be paid will be about $4. Those remaining
reimbursements continue to be prioritized and sent out the
door. We anticipate those few remaining claims will be
completed by February 1, 2022.
We note that you asked for claims and payment data by
state. There are a few reasons we are not able to cut this
data cleanly by state, including that providers submit claims
via tax identification numbers (TIN), many of which cover
physicians (and therefore claims) from multiple states.
You also asked for additional information about how we will
shorten the adoption time of new rates in this or a future
national public health emergency (NPHE). As we stated
previously, contracts between United and its network provider
groups specifically provide for time to implement new rates
in an orderly way. We understand this to be routine across
the industry, understood and long accepted by the provider
community, and entirely proper. If there is another NPHE or
there are exceptional circumstances which dictate more timely
adoption of new rates, we have learned over the past few
months the required technology and human resources that need
to be brought forward to accelerate. As a point of reference,
should circumstances justify it, we commit to implement new
codes in an NPHE faster than industry standard.
John Prible,
Vice President, External Affairs,
UnitedHealth Group.
____________________