Wiki Oscar Insurance vaccine denial issue

[jolenm]

Have any other Pediatric practices been getting Oscar insurance rejections for the MMR II, Varivax, and Hiberix vaccines due to "invalid NDC unit of measure"?
We give .5ML doses for each vaccine and that is what we report, yet Oscar continues to deny these vaccine codes and upholding denials on appeal for the past year. They are the only private insurance doing this. ALL other private insurances are paying these vaccine codes including BCBS, UHC, Aetna, Cigna, and Tricare military insurance.
We can't get any help from Oscar. You can never speak to anyone in the claims department and we have no dedicated provider representative, despite numerous requests. Anytime I request to speak with a supervisor, I'm put on hold for 30-45 minutes then disconnected. At this point, I don't know what to do and am hoping someone from another pediatric practice may be able to help.

 

[Amandar03]

Hello Jolen,

I’ve been having the same issue with Oscar in regard to vaccines. However, they don’t cover any of them, making parents responsible for 50% co-insurance. I spoke to them yesterday and was on the phone with them for about an hour and they still didn’t resolve my issue, they told me to contact our biller, my response I am the biller which is why I am contacting you guys because out of all the insurances, they are the ones that give me the most trouble for absolutely everything. I even spoke to supposedly a Manager name Kendyl, her response was that they need to be medically necessary, my response to her they are medically necessary if it's preventive care what do you mean? Her response was that she was going to escalate my claims to review. As of now, I'm not even sure how else to code it because everything I do comes back as the parent's responsibility which I believe is unfair for the parent since it should be fully covered. Mind you this has been going on since September of last year, so you can imagine my frustration.