In the midst of the rising measles outbreak in West Texas, Thang Nguyen, a postdoctoral fellow at the University of Texas Medical Branch (UTMB), became concerned about his 4-year-old son’s health. His son, Anh Hoang, had only received the first dose of the measles vaccine, putting him at risk.
To ensure his family’s safety, Nguyen took them to a primary care clinic in Galveston in mid-March to receive their immunizations. However, the visit led to a series of unexpected and hefty medical bills, despite assurances that the family’s insurance would cover the costs.
The Immunization Visit and Cost Shock
During the visit, Anh Hoang received an MMRV vaccine, protecting against measles, mumps, rubella, and chickenpox, along with additional immunizations for tetanus, diphtheria, and whooping cough.
Nguyen’s twin daughters, who had already been vaccinated for measles, received other required immunizations. Nguyen, who works at UTMB, asked clinic staff whether his insurance would cover the checkups and vaccines and was told it would.
However, the family was shocked when the bills arrived. UTMB charged $2,532 for the visit and the three vaccines, with the MMRV shot alone billed at $1,422, plus an additional $161 for its administration.
The insurance plan purchased for the family, which was administered by the International Medical Group, did not cover vaccinations, leaving the family with significant out-of-pocket expenses.
Health Insurance and Coverage Gaps
The health plan purchased by Nguyen for his wife and children, costing $1,841 for the year, provided coverage for certain types of care, such as emergency room visits, hospitalization, and chemotherapy, but excluded preventive care, including vaccinations.
This exclusion led to the unexpected financial burden, particularly in light of the measles outbreak, which had already infected over 750 people in Texas.
Nguyen, who earns less than $57,000 annually, found the high medical costs especially burdensome. In Vietnam, where he and his family are originally from, Nguyen estimated that the total cost of the immunizations would have been no more than $300. He expressed frustration at the high costs of the vaccines in the U.S., particularly during an outbreak of a preventable disease.
Billing Errors and Price Increases
Upon investigating the issue, Kent Pickering, UTMB’s vice president of clinical contracting strategies, explained that the family’s insurance information had been entered incorrectly into the clinic’s system, which prevented them from checking whether the Texas Vaccines for Children Program (TVFC) would cover the shots.
Additionally, a recent update to UTMB’s chargemaster had resulted in the vaccines being billed at much higher prices than they would have been through the TVFC, which provides free vaccines for uninsured and underinsured children.
The CDC’s Vaccines for Children Program price list shows that the cost of the MMRV vaccine in the private sector is typically around $278, while Galveston-area pharmacies list prices ranging from $285 to $326. However, UTMB had billed the Nguyen family approximately $1,400 for the vaccine, far exceeding the expected cost.
Resolution and Relief
After reaching out to both the insurer and the financial offices at UTMB, Nguyen was initially offered a 50% self-pay discount, lowering his bill to $1,266. However, after further discussions with customer service and intervention from KFF Health News, UTMB agreed to waive the cost of the vaccines entirely.
Nguyen’s final bill was reduced to just $202.75 for his son’s office visit, with similarly reduced charges for his daughters’ care.
The Takeaway: Navigating Medical Costs and Insurance Coverage
This experience highlights the challenges that many families face when dealing with healthcare costs, especially when insurance plans fail to cover essential preventive care.
Medical billing experts advise checking with insurers before scheduling elective treatments like vaccinations, especially for families with non-ACA-compliant health plans.
Public health programs, like the Texas Vaccines for Children Program, can offer low-cost or free immunizations for uninsured or underinsured children, but these programs may face funding challenges due to government budget cuts.
Additionally, families without insurance or with inadequate coverage can inquire about self-pay discounts or charity care policies that may be available at certain healthcare providers.
The Nguyen family’s experience underscores the difficulties many families face when navigating the U.S. healthcare system, particularly when it comes to preventive care and vaccines.
It also serves as a reminder of the importance of having comprehensive health insurance coverage, especially during times of public health crises like the ongoing measles outbreak.
