Title: Americans Face Insurance Headaches as Government No Longer Distributes COVID Shots
Subtitle: Vaccine coverage and costs become more complicated as Americans navigate insurance networks
September 22, 2023 at 6:00 a.m. EDT
As the federal government’s involvement in distributing COVID-19 shots comes to an end, Americans are encountering unexpected challenges with their insurance coverage. Many individuals attempting to get vaccinated have been denied coverage or charged exorbitant fees, highlighting the complexities of dealing with insurance companies and a for-profit healthcare system.
Previously, federal officials had promised that the updated COVID shot would be free and covered by insurance. However, Americans are finding that the reality is different. Issues range from pharmacies being out of network and vaccines not appearing on approved medical expenses lists, to requiring prior authorization. Some individuals have ended up paying out-of-pocket to avoid waiting, while others have not been given that option.
This transition from viewing COVID vaccines as a public good to treating them as commercial products has created new challenges. Mandy Cohen, director of the Centers for Disease Control and Prevention, stated, “Last year there was one player – the federal government. And now there’s a lot more players and… they’re not accountable to us.”
Although Cohen assures that most issues should be resolved within days, this provides little comfort to Americans eager to get vaccinated quickly.
For example, Eric Allix Rogers, who had a severe case of COVID-19 in 2021 before he could get vaccinated, paid $155.99 for the updated vaccine after his insurance provider, Blue Cross Blue Shield of Illinois HMO plan, did not cover the shot. Rogers did not want to risk another infection during an upcoming work event in Minneapolis.
Insurers have urged members to use in-network pharmacies for free vaccines and have advised them to contact customer service if they face any challenges. While the number of individuals experiencing these difficulties is unclear, many similar stories have circulated on social media, prompting acknowledgement from federal officials, insurers, and pharmacy chains that these issues are not isolated incidents.
In a letter from Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, insurers – both public and private – were instructed to ensure their systems are prepared to cover the costs of COVID vaccines immediately.
Responding to reports of unexpected insurance denials, the CMS has been working with plans to update their systems and reminding them of the requirement to cover authorized COVID vaccines without cost-sharing. The Biden Administration also reiterates its commitment to ensuring widespread availability of vaccines at no cost to the American public.
Meanwhile, industry group America’s Health Insurance Plans is collaborating with the federal government, pharmacies, and other partners to resolve billing code errors and ensure patient access to COVID-19 vaccines with no cost-sharing.
Separately from insurance troubles, some Americans have struggled to find places offering the new vaccines or have had their appointments canceled due to logistical issues. However, administration officials assure the public that manufacturers and distributors are working to address these challenges, emphasizing that there is no vaccine shortage.
While overall demand for the new vaccine is expected to be low, providers anticipate an initial surge from individuals keen on protecting themselves against the latest variants and hospitalizations.
The road to getting vaccinated in today’s landscape is not without its hurdles. Americans can no longer expect to receive a vaccine wherever they want as insurers are not obligated to cover vaccines administered at out-of-network pharmacies and locations.
The transition from a government-run program to a more complex system has left many Americans frustrated and uncertain about the vaccination process. However, health officials are hopeful that these issues will be resolved soon, and vaccines will continue to be easily accessible to all.