Why Don’t We Bill Insurance?

This is probably the most frequently asked question we get. Some clinics, especially those associated with a medical center, do bill insurances. Most private travel clinics don’t. Instead clients are given forms with all the necessary information to submit to their insurers for possible, direct reimbursement.

Most insurers do not cover travel vaccines. Medicare does not cover travel vaccines at all. (They only cover flu and pneumonia and hepatitis B under very limited circumstances and herpes zoster vaccine under optional plan D). The reimbursement rate for vaccines is slightly above or below the cost of the vaccine. Vaccine prices rise faster than reimbursement rates do. To make up for this, an administrative fee for each vaccine is added. Some clinics that do not bill third parties charge administration fees, too. Most don’t. The office charge for a clinic that bills in our area is about $250. Those that don’t bill direct charge much less. We charge $85 per person or $100 for two people traveling together.

So, what do we tell the consumer?

We tell them to call their insurer and ask if they cover travel health office visits and travel vaccines. They have to ask specifically about travel vaccines or they may find out that they were told they were covered but that they didn’t mean yellow fever. If they cover it all, they can go to a clinic that bills direct or may still choose to go to one that doesn’t and submit the form themselves. If you do not bill insurance you still need an NPI number and need to give the clients statements with proper coding. Other factors that determine how consumers choose travel care are location, convenient hours and the reputation of the clinic.

Even though we have client’s that don’t come to us because we won’t bill, I don’t regret that business decision. It would cost us alot more to bill and collect fees that were denied by the insurer because they were not covered, had a high deductable, etc. Because we don’t bill, I can spend more time providing direct client care than dealing with administraive and billing problems.

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