UnitedHealth Group has committed to reprocessing all of its commercial claims related to COVID-19 vaccine administration, after federal investigators confirmed the nation's largest insurer paid "millions" of provider bills 40% less than the Medicare rate for inoculating patients.
Officials are relying on UnitedHealth to identify how many bills from March to July need to be repaid, according to a letter from Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, to UnitedHealth Group CEO Andrew Witty on Thursday.
For every 1 million claims UnitedHealthcare reprocesses, the company will owe providers $15 million. Claims across UnitedHealthcare's entire book of business will likely need to be repaid, except for potentially those in the state-regulated Medicaid managed-care space.
The Minnetonka, Minnesota-based healthcare giant must provide the Senate Aging Committee answers to who and how much it owes by Nov. 5.
"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," Casey wrote in an email. "I urged UnitedHealth to reprocess these payments, which will help children, older adults and their families get vaccinated and stay healthy. The company's commitment is an important step to combat the ongoing COVID-19 pandemic, which I will continue to monitor going forward."
With the delta variant surging and the Food and Drug Administration set to approve booster shots and jabs for children any day, low fees for vaccine administration could threaten patient access to these services, worsening the public health crisis, the letter says.
Older adults living in multigenerational houses will be most impacted by UnitedHealthcare's failure to reimburse pediatricians and other providers at reasonable rates, since living with unvaccinated individuals places them at a greater risk of exposure to coronavirus. Seven million grandparents live with family members under the age of 18, the Aging Committee said.
"The ongoing effort to increase COVID-19 vaccination rates across our nation demands an all-hands-on-deck approach," the letter reads. "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."
UnitedHealthcare has added a note to its website saying it understands "the importance of reimbursement to providers and the effect it has on ensuring they are able to provide vaccinations" and that it will adjust claims paid below the Medicare rate from March 15 to June 30. The company will repay in-network providers and has been reimbursing clinicians $40 for administering vaccines since July 1, a spokesperson wrote in an email.
Senior UnitedHealthcare officials told Casey's office that they hope to make "significant progress" toward paying providers within 45 days.
"The rate changes are in progress and claims will be adjusted in the upcoming weeks," UnitedHealthcare's website reads. "Providers do not need to take any action for these adjustments to be processed."
At the end of the company's most recent third quarter ended Sept. 30, UnitedHealth Group's revenue grew 11% year-over-year to $72.3 billion. The company has increased its 2021 earnings outlook at least twice this year.
After Modern Healthcare first reported on UnitedHealthcare's below market reimbursement tactics, investigators with Casey's office spoke to the American Academy of Pediatrics, providers, Pennsylvania state officials and healthcare experts to confirm that UnitedHealthcare was shortchanging clinicians, jeopardizing access to the main tool for stopping the virus' spread.
While UnitedHealthcare is not legally required to pay the recommended federal rate, federal investigators confirmed it was the only national carrier that had not agreed to pay at least $40 for vaccine administration. Unlike most medical services, federal legislation bars providers from balance billing patients for the COVID-19 vaccine.
When the Senate Aging Committee reached out to UnitedHealthcare, and the company blamed its low rates on its size, saying it had so many different physician fee schedules that it was having trouble responding to updated rates and codes set by the Centers for Medicare and Medicaid Services.
In March, CMS 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. The agency said it expected commercial carriers to follow suit in offering clinicians a reasonable rate.
In October, UnitedHealthcare pledged to the Aging Committee that it would review and streamline its process for repaying providers, and verify that there are no similar underpayment issues in its Affordable Care Act and Medicaid managed-care businesses.
But the company said providers should expect delays in receiving their checks, since its payment systems will need time to reflect CMS' new codes and rates, the letter said. By Nov. 5, the company must tell the Aging Committee how it plans to update its infrastructure to ensure it is able to respond in a more timely manner when CMS issues new rates for COVID-19 or other emergent vaccines and therapeutics going forward.
The Aging Committee does not have plans to further investigate UnitedHealthcare. But federal regulators are still investigating UnitedHealth Group's $13 billion proposed acquisition of revenue cycle management Change Healthcare, a deal that has attracted the opposition of providers and antitrust advocates. UnitedHealth Group has said it expects the deal to close in the first half of next year.
"If you're going to get that big, part of the acquisition and merger strategy must be 'how can we make sure things like this don't happen and we can manage our information?'" said Dr. Sue Kressly, who chairs the AAP's payment advocacy advisory committee and runs Pennsylvania-based Kressly Pediatrics. "Some of the profits have to go back into infrastructure coordination and harmonizing the information and systems."
In addition to offering low reimbursements for vaccines, UnitedHealthcare has also paid providers for less than what it cost them to purchase COVID-19 testing kits. Despite significant media attention over the last eight months about the issue, the AAP has said that UnitedHealthcare continues to pay pediatricians and family medicine providers below-market rates for some tests, threatening patient access and the future of independent clinicians offices. UnitedHealthcare has also made it difficult for physicians to recoup the money it owes them for tests that it promised to reimburse them for.
Conversations with UnitedHealthcare about payment for coronavirus tests are ongoing, Kressly said. She feels cautiously optimistic the issue will be resolved.
"When you're vertically integrated, there is a patient-first mentality, and there is a profit-first mentality," Kressly said. "Do we want to make profits over patients? Who loses and who wins when we do that?"