jshields
Contributor
Has anyone had any feedback with the new Gardasil(HPV) vaccine? Any major reimbursement issues? Any specific carrier problems?
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Gardasil Feedback?
lflocca1
New
Hi, from Michigan, we get reimbursed from HAP and BCBSM only if the patient has the rider for vaccination coverage on their policy. Also some other 3rd party payors will make payment, but it really depends on the policy that the patient has.
Gardasil is Tricky
I had an issue with United Healthcare in Kentucky. The physician had seen the patient on the same day as the vaccine and billed an office visit with a separate diagnosis. United processed both diagnosis listed which were assigned separately, to the vaccine. This was a huge mess to get United to review the original HCFA and diagnosis that matched the vaccine. It is very important to check the patient's benefits upfront. For intstance, United does cover the vaccine under their "wellness" program. However, if the patient can get their vaccines separate from office visits it should make the claims run much smoother.
Jessica
I had an issue with United Healthcare in Kentucky. The physician had seen the patient on the same day as the vaccine and billed an office visit with a separate diagnosis. United processed both diagnosis listed which were assigned separately, to the vaccine. This was a huge mess to get United to review the original HCFA and diagnosis that matched the vaccine. It is very important to check the patient's benefits upfront. For intstance, United does cover the vaccine under their "wellness" program. However, if the patient can get their vaccines separate from office visits it should make the claims run much smoother.
Jessicadannimom
Contributor
PA Blue Shield and BC of NE Pennsylvania are only covering the vaccine to age 22 and not the CDC recommended age of 26. We got stuck especially since it is a series of three injections.
xlbctso
Networker
Gardasil is a state supplied vaccine under the pediatric immunization law in Rhode Island. The insurers here pay a vaccine tax to fund the purchasing by the State of vaccines for children up to the age of 19 yrs. Providers submit the vaccine code (needed for tracking purposes for HEDIS) and the administration code. Since the vaccine is state-supplied, providers are paid only for the admin.