The annual flu shots, which are free for those with health insurance, are not immune to the confusing and despicable price gouging that plague the US healthcare system.
Health insurance companies pay very different amounts for the same vaccines, depending on how they negotiate with individual health providers across the country. In some cases, providers force insurers to pay three times what they pay to other providers, according to a study by Kaiser Health News.
The agency noted that there was an insurer in a doctor’s office in Sacramento, California that paid $ 85 for a flu shot that he offered to uninsured patients for $ 25.
Although $ 85 may seem insignificant in the overblown U.S. healthcare scheme, such prices add up quickly as tens of millions of people get the flu shot every year. Although the Affordable Care Act requires insurers to cover the full cost of all federal-recommended vaccines, including the flu vaccine, any additional costs for insurers will be borne by patients at higher premiums, KHN economists said.
Considering further that insurers paid for influenza vaccines, KHN found that costs span the entire range of $ 25 to $ 85. A doctor in Long Beach, California, forced Cigna to pay $ 47.53 for vaccination, and CVS in downtown Washington, DC, received $ 32 from Cigna for the same shot. A CVS just 10 miles from Maryland received $ 40.
My insurance was a little better than those. My doctor's office in the District of Columbia initially charged $ 35 for my flu shot from my insurer, Etna, and Etna paid them an agreed rate of $ 24.50.
But this is still significantly higher than the rates agreed at the federal level. The Centers for Disease Control and Prevention agreed on a price of just under $ 14 for the same shot. The agency reported that the cost of the private sector is about $ 18. Similarly, Medicare and Medicaid Services centers pay $ 18 for a vaccine.
Etna paid about 35% more than for my identical shot – and I did not have the opportunity to find out before I get the shot. Hidden contract prices do not allow patients to go shopping. And this is not just a problem for flu shots. Wild price fluctuations occur for everything from diagnostic scans to surgeries.
“We do not have a functioning healthcare market because of all this lack of transparency and opportunities for price discrimination,” said KHN Glenn Melnik, a health economist at the University of Southern California. “Prices are inconsistent and confusing consumers,” he added. “The system does not work to provide effective care, and the flu shot is one example of how these problems persist.”