View the different scenarios to see how much you can save by opting to utilize your employees' insurance. Since you already pay for your employees’ health insurance, this service ensures you don’t pay full price twice!

How Our New Flu Shot Billing Service Works

1. In-Network Insurance Billing:
   After your flu shot event, we export participant data to our medical billing contractor (following HIPAA compliance) and they bill the insurance companies directly for flu shot costs. Some plans cover the full cost, others cover a percentage or a set amount. If there’s a remaining balance (co-pay or coinsurance), we will send that bill to you.
2. Participant Verification Process:
   To limit declined claims, our staff will verify each participant’s insurance details by reviewing their insurance card directly before administering the shot. Participants must bring their insurance card to the flu clinic. This verification helps ensure smooth billing and may take slightly more time, but we are fully HIPAA compliant and maintain strict confidentiality to protect all personal data.
3. Minimum Shot Requirement:
   We require an estimated participant count for planning. For example, an estimate of 50 participants sets a minimum of 45 shots, and we prepare for up to 60. If fewer than the minimum shots are administered, you’ll be charged the cash price of the flu shot for the shortfall to meet the minimum.
4. Handling Multiple Insurance Providers:
   Before the event, we confirm our in-network status with your company’s insurance providers (e.g., Kaiser, Sutter Health, etc.). We accept cards from in-network providers only. For employees with non-network insurance or no insurance, you can choose to cover their full cash price flu shot cost or opt them out of the event.
5. Flu Shot Pricing:

• Standard Flu Shot
• Cash price (no insurance): $53
• Insurance-billed price: $75
• High-Dose Flu Shot (Ages 65+)
• Cash price (no insurance): $105
• Insurance-billed price: $135
• Travel Fees: Events beyond 125 miles from Sacramento may incur additional travel fees, which we’ll confirm during planning.

With insurance billing, costs are significantly reduced based on the reimbursement rates: Insurance A covers $70 per standard shot, Insurance B covers $45 per standard shot, and Insurance C covers $60 per standard shot, with all 3 insurances covering $90 per High-Dose shot.

For an event with 100 participants (50 covered by Insurance A at $70 reimbursement, and 50 by Insurance B at $45 reimbursement), here’s the breakdown (assuming no travel fees and all standard shots):

• Insurance A Balance: ($75 - $70) × 50 = $5 × 50 = $250
• Insurance B Balance: ($75 - $45) × 50 = $30 × 50 = $1,500
• Total Cost to You: $250 + $1,500 = $1,750 (or $17.50 per shot)

Without insurance billing, 100 standard shots would cost $5,300 (100 standard at $53), saving you approximately 67%!

For an event with an estimated 50 participants (minimum 45 shots), where 42 shots are administered (16 covered by Insurance A at $70 reimbursement, 12 by Insurance B at $45 reimbursement, and 14 by Insurance C at $60 reimbursement), here’s the breakdown (assuming no travel fees and all standard shots):

• Insurance A Balance: ($75 - $70) × 16 = $5 × 16 = $80
• Insurance B Balance: ($75 - $45) × 12 = $30 × 12 = $360
• Insurance C Balance: ($75 - $60) × 14 = $15 × 14 = $210
• Shortfall to Minimum: $53 × 3 shots = $159 (45 minimum – 42 administered; cash price for shortfall)
• Total Cost to You: $80 + $360 + $210 + $159 = $809 (or ~$19.26 per shot for 42 shots)

Without insurance billing, 45 standard shots (minimum) would cost $2,385 (45 standard at $53), saving you approximately 66%!

Scenario #4: 35-Participant Estimated Event (30 Shots Administered)

For an event with an estimated 35 participants (minimum 31 shots), where 30 shots are administered (all covered by Insurance A at $70 reimbursement per standard shot; 20 standard shots and 10 high-dose shots), here’s the breakdown (assuming no travel fees):

• Insurance A Balance (Standard): ($75 - $70) × 20 = $5 × 20 = $100
• Insurance A Balance (High-Dose): ($105 - $90) × 10 = $15 × 10 = $150
• Shortfall to Minimum: $53 × 1 shot = $53 (31 minimum – 30 administered; assuming standard cash price for shortfall)
• Total Cost to You: $100 + $150 + $53 = $303 (or ~$10.10 per shot for 30 shots)

Without insurance billing, 20 standard + 10 high-dose would cost $2,110 ($53 × 20 + $105 × 10), or $1,643 for minimum-based (31 standard at $53), saving you approximately 80–85% depending on comparison.