Why Everyone Wants to Give You a Free Flu Shot
In theory, when money is exchanged for goods or services, there must be some relationship between the amount of money and the value of the thing purchased. But since health insurance is such a strange system, in practice this does not happen.
When you get your flu shot, with private insurance:
- The patient (you) asks for an injection.
- The clinic asks your insurance for money.
- The clinic pays for the insurance.
- Federal law prohibits the clinic from charging you copay, deductible, or co-insurance for flu shots , so you won’t get billed.
- The cost of the flu shot is paid from the rest of the plan’s money, which ultimately comes from premiums, which is your monthly payment.
Who benefits from here? As a patient, you get a “free” flu shot, but you end up paying for it in one way or another. (You also get flu protection, which is still a win.) The insurance company pays for the vaccine, but they also get a client / patient less likely to get the flu, which ultimately saves them money. But the clinic probably gets the best of the three.
Think about it: they might be selling flu shots by saying, “Hey, why not? It’s free. ”And then they can turn around and charge the insurance company for pretty much whatever they want.
The flu shot costs $ 20 to $ 40 out of pocket, but Kaiser Health News found Cigna paid up to $ 85 for some flu shots . Why? Because the price of a flu shot depends solely on the deal between the insurance and the provider. This is true for almost any medicine, procedure or other medical fee: prices are negotiated between two giant companies, and we, as consumers, have no say, and often no choice, in this matter.
“Sutter has tremendous influence in California and insurers have no choice but to pay Sutter the price,” one health policy professor told the Kaiser. (Sutter is the provider who charged Cigna $ 85 and advertised flu shots for $ 25 to people without insurance.)
Any flu vaccination provider – be it a doctor’s office, an ambulance or a pharmacy – wants your sweet sweet insurance money and also offers you a door in hopes of coming back another time. Pharmacies have other incentives as well. If you go to CVS or the grocery store for a flu shot, you can buy a few things while you’re there. If the store offers a coupon or gift card, you will definitely buy things while you’re there, and your purchases are likely to be more than the $ 5 they sent you.
As consumers, we don’t have much control over what goes on behind the scenes, but at least it’s nice to know why everyone is trying to sell you a free item every fall.