When Paul Moser considers getting a coronavirus vaccine, he also thinks about his outstanding medical debt: $ 1,200 from some urological visits that he was unable to pay off.
Mr. Moser, 52-year-old gas station cashier in New York State, has friends surprised by bills for coronavirus testing, fearing the same could happen to the vaccine. Right now he's holding back to get his shot.
"We were told by lawmakers that all testing should be free, and then it's surprising it's $ 150," he said. "I agree that getting vaccinated is important, but I have no sense of urgency."
Congress passed laws banning pharmacies and hospitals from charging patients for coronavirus vaccines. Signs at vaccination sites indicate that the shot is free. From the start, health officials and government leaders have told the public it won't cost anything. And there have been few reports of indictments from individuals.
Even so, some unvaccinated adults cite concerns about a surprise bill as a reason for not getting the shot. Many of them are used to a healthcare system where the bills are frequent, high, and often unexpected.
A recent survey by the Kaiser Family Foundation found that about a third of unvaccinated adults weren't sure if insurance covered the new vaccine and feared they might have to pay for the shot. Concern was particularly pronounced among Hispanic and Black respondents.
“The conversations we have are like, 'Yeah, I know it's good. Yes, I want to, but I don't have insurance, ”said Ilan Shapiro, medical director of AltaMed, a community health network in southern California that serves a large Hispanic population. "We're trying to make sure everyone knows it's free."
The confusion may be due to a lack of information or a skepticism that a bill won't follow a doctor's visit. Liz Hamel, director of survey research at Kaiser, said it might reflect people's experience of the healthcare system: "People might have heard it was free but they don't believe it."
Congress has tried to protect patients from bills for coronavirus vaccines and tests. At the start of the pandemic, it ordered insurers forego co-payments and deductibles for both services and set up a fund to reimburse doctors who see uninsured patients.
Still, patients faced test bills – some for over $ 1,000. Some doctors billed uninsured patients for tests instead of the new federal fund. Others looked at unexpected fees and services for the test visit.
The rules for billing vaccines became even stricter. In order to become vaccinated, doctors and pharmacies had to sign a contract in which they did not charge patients for vaccinations.
The stronger protection seems to have worked. While many patients have come across coronavirus bills for testing – the New York Times documented dozens of cases in bills submitted by readers – there have only been a handful of vaccines.
Still, some unexpected charges got through: Patients in Illinois, North Carolina, and Colorado were falsely received vaccine bills. In all cases, the vaccine providers have reversed the charges and apologized for the mistakes.
The federal government has received some complaints about unexpected fees and recently warned doctors not to bill patients.
Surprising bills for coronavirus vaccines, tests, and other medical supplies can make an impression on patients. According to a 2013 study by Lucie Kalousova, an assistant professor of sociology at the University of California, Riverside, Americans with medical debt are more likely to skip necessary care than people with other types of debt, such as outstanding credit card bills or student loans.
“For someone in medical debt, they may be told by the media and everyone else that the vaccine is free, but they also have had this very negative previous encounter with the medical system that has generated suspicion. " She said.
Some patients who were concerned about the cost of a coronavirus vaccine said they always expect a bill to follow a doctor's appointment. Quoting stories from friends or family members who were receiving expensive coronavirus tests and treatment bills, they wondered why the vaccine would be any different.
"This is America – your health care isn't free," said Elizabeth Drummond, a 42-year-old mother from Oregon who is not vaccinated. “I just have a feeling that this is how the vaccination process will work. They will try to capitalize on it. "
It's also possible that poll results overstate how many Americans fear getting a surprise vaccine bill. When the Times conducted follow-up interviews with Kaiser's help, some respondents expressing this concern said it didn't matter much to them.
Instead, they said they responded this way to express their frustration with the vaccine or the entire American healthcare system.
"Cost is the smallest detail," said Cody Sirman, a 32-year-old who works in manufacturing in Texas who chose not to get vaccinated. He said he wouldn't mind paying for the vaccine if he trusted him – but he doesn't say, "I think the vaccine is an outright sham. It was just a way to see how much control it was Government over the population. "
For many, the potential cost of a vaccine is only part of a range of reasons to stay unvaccinated. It can often be difficult for pollsters to pinpoint the determining factor – or even identify patients. Separate research by the Census Bureau last month found Americans were more concerned about vaccine side effects than potential charges.
“Most people don't say they are only concerned about one thing; That's usually a lot of things, ”said Ms. Hamel from the Kaiser Family Foundation.
Tiffany Addotey, a 42-year-old school bus driver in North Carolina, has concerns about the cost. This is mainly due to their experience of taking a coronavirus test.
"What worries me is that some places have been charged around $ 200 for coronavirus testing," she said. “I haven't paid. I went home. I have enough bills for the way it is. "
There are other things that concern them, such as the safety of the vaccine given its rapid development, as well as Johnson & Johnson's recent vaccination break.
When Ms. Addotey was informed that federal law makes the vaccine free for all Americans, she replied, "So I just have to pay my co-payment?"
Learning that it was really going to be free, with no additional payment, "helped a little," she said. But it wasn't enough to calm her down, at least not yet.
"I'll try and wait a little longer," she said. "I feel like after a little more research and a little more time, I'll get it."