Federal officials promised the new covid shot would be free and covered by insurance, but some Americans have encountered a different reality this week as they tried to get vaccinated, only to be denied coverage or charged up to $200.
They have faced myriad complications, from pharmacies being out of network, to the vaccine not showing up on lists of approved medical expenses, to needing prior authorization. Some Americans paid out of pocket to avoid waiting. Others say they weren’t even given that option.
The hiccups reflect a new reality for covid vaccines as they go from being treated as a public good to a commercial product. Now that the federal government is no longer buying and distributing all the shots, Americans must endure the usual headaches of dealing with insurance companies and a for-profit health care system.
“Last year there was one player — the federal government,” Mandy Cohen, director of the Centers for Disease Control and Prevention, said in an interview. “And now there’s a lot more players and … they’re not accountable to us.”
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In a July letter, Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, told public and private insurers to make sure their systems are prepared to immediately cover the costs of covid vaccines in the fall.
After hearing reports of unexpected insurance denials, CMS has been working with plans to ensure their systems are up to date and is reminding them they must immediately cover authorized covid vaccines without cost sharing, according to a statement provided by Health and Human Services spokeswoman Ilse Zuniga.
“The Biden Administration will continue working to ensure COVID-19 vaccines are widely available to the American public at no-cost to them from their local provider, community health center or pharmacy,” the statement said.
Federal officials and health experts say some of these insurance problems appear to be a result of insurance systems that have yet to be updated and billing code errors should be resolved in the coming weeks.
“We are working closely with the federal government, pharmacies, and other partners to quickly ensure patient access to COVID-19 vaccines with $0 cost sharing and address any issues relating to newly added billing codes quickly,” James Swann, a spokesman for the industry group America’s Health Insurance Plans, wrote in an email.
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