Question Insurance Plans Not want to Pay for COVID-19 vaccine Administration


Brooklyn, NY
Best answers
I have two payers that have refused to pay for Covid-19 administration for my OON provider. Even though the admin cpt code is correct and the NDC# is correct. I have to file Appeals for them to reconsider their denials. I can not find exactly where in the law it says Private Health insurance plans are to pay in-network and out-of-network providers. Can anyone point me to where the law exactly says this? Has anyone else had this problem? If so, how did you get the claim paid?
We'll need more information for this. What insurance does this refer to? Was this billed with an E/M? If so, have you appended modifier 25 to the E/M for the administration?