Now that the government has stopped purchasing and distributing all vaccines, Americans will have to endure the usual headaches from insurance companies.
The issue reflects a new reality as coronavirus vaccines move from being treated as public goods to being commercial products. Now that the federal government is no longer purchasing and distributing all vaccines, Americans must endure the usual headaches of dealing with insurance companies and for-profit health systems.
“One of the players last year was the federal government,” Mandy Cohen, director of the Centers for Disease Control and Prevention, said in an interview. “And now we have more players, but they are not responsible for us.”
Cohen said most issues should be resolved within days, but that’s little consolation for Americans trying to get vaccinated as soon as possible.
Eric Alix Rogers paid $155.99 for his latest vaccine despite receiving a call from a Chicago pharmacy offering to reschedule his appointment Monday. Blue Cross Blue Shield HMO Plans in Illinois. He had a bad case of the coronavirus before getting vaccinated in 2021, and he doesn’t want to risk a new infection when he travels to Minneapolis for a large work event next week. There is.
“We are being told we need to move to treating COVID-19 as a routine problem, but health leaders don’t understand how to treat it as a routine issue. “Hmm,” said Rogers, 38. complicated. “
A spokesperson for the Rogers insurance company said members can get the free vaccine at in-network pharmacies and call customer service if they run into difficulties. It’s not clear how many challenges people like Mr. Rogers are facing getting vaccinated, but social media is full of similar stories, and federal officials, insurance companies and pharmacy chains believe these are isolated incidents. I admit that it is not.
in July letterChiquita Brooks LaSure, Administrator of the Centers for Medicare and Medicaid Services, will ask public and private insurers whether they are positioned to immediately cover the cost of coronavirus vaccines in the fall. I asked.
In response to reports of unexpected insurance denials, CMS is working on a plan to ensure its systems are up-to-date and is updating approved new models, according to a statement from Department of Health and Human Services spokeswoman Ilse Zuniga. It is calling attention to the need to immediately provide coverage for coronavirus vaccines at no cost. .
“The Biden Administration remains committed to making coronavirus vaccines widely available to the American people at no cost through local health care providers, community health centers, and pharmacies,” the statement said.
Federal officials and health experts say some of the insurance problems appear to be because the insurance system hasn’t been updated yet, and that the billing code errors should be resolved in the coming weeks.
“We are working closely with the federal government, pharmacies, and other partners to ensure rapid access to COVID-19 vaccines to patients at zero cost and to address issues related to newly added billing codes. We are quickly addressing this issue,” industry spokesperson James Swan said. America’s Health Insurance Plans Group wrote in an email.
Aside from insurance issues, there are also reports of Americans having trouble finding places offering the new vaccine or having their appointments canceled. Government officials said manufacturers and distributors are working to resolve logistical issues that caused some delays and there are no shortages of vaccines.
Ann Zinke, chief medical officer for the Alaska Department of Health, said the vaccine team is very frustrated with the latest vaccination drive.
“Our team is not aware of the availability of vaccines in the state and is calling pharmacies door to door to see if they can find a vaccine,” she wrote in a text message.
Overall demand for new vaccines is expected to be low. 17 percent of eligible Americans received the bivalent booster that was approved a year ago. But health care providers expect an initial surge in demand for new vaccines from people most concerned about protecting themselves from the virus.
Hospitalizations due to the coronavirus have been on the rise since July, and new vaccines target the latest variants in circulation.Data shows prevention of hospitalization with previous vaccines fades after 4 monthsEspecially for the elderly and immunocompromised.
Leesa Weiss will have to pay nearly $200 for the latest COVID-19 vaccine because her Medicare plan won’t accept the billing code for prefilled Pfizer syringes, a pharmacist at a Maryland CVS apologetically told her. He said he was told not to do so. Weiss said she wanted to get vaccinated during Monday’s appointment because she is two weeks away from a planned trip to Europe. She also said that because it takes two weeks for the coronavirus vaccine to provide maximum protection. She insists CMS should provide the syringes free of charge.
Weiss, 67, said: “This may be a problem. I hope it will be successful before I go abroad, but if not, I will sit back and wait.”
But one common problem that remains unresolved is that Americans can no longer expect to receive the vaccine where they prefer, as insurance companies are no longer required to pay for vaccines administered at out-of-network pharmacies and locations. That’s it.
“Under the national program, anyone could go anywhere, regardless of their insurance status,” said Kelly Moore, CEO of Immunize.org, which educates health care workers about vaccines. . “We still offer the same free vaccination opportunities to everyone, but they are more limited than before.”
Moore himself experienced challenges. Due to shipping delays, he was unable to get vaccinated at his usual pharmacy and was told he would have to pay $200 at CVS because he did not have insurance. It took several hours and a few frustrating phone calls for her to resolve the situation and finally get vaccinated at Walgreens, but I fear that uninformed consumers will give up when they encounter hurdles. She is concerned that this may not be the case.
Ximena Levander and Philip Kast, a Portland, Oregon couple, want to boost their immunity ahead of their wedding next week, especially since their 3-month-old daughter is too young to be vaccinated. That’s what I was thinking. However, pharmacies in his insurance network did not have the coronavirus vaccine in stock, and he was unable to pay the full price at his local Walgreens store.
They said Walgreens staffers gave conflicting reasons as to why they were not being paid and blamed the vaccine manufacturer, the government and company policies on various points.
“They said Walgreens wants your money and if they can find a way to charge you, they will,” said Levander, 39, an internist.
Walgreens spokeswoman Stephanie Corcilius said out-of-network patients should be allowed to pay out of pocket, and the company would follow up with its stores.
“Walgreens pharmacists know the procedures for filing insurance claims and are available to assist those with questions,” Corcilius wrote in an email. “We encourage everyone to bring their insurance information to their appointment if possible, but we will not turn away anyone who is not covered by insurance.”
After the Washington Post investigation, the couple received a call back from Walgreens and were able to pay cash to get vaccinated on Thursday.
Casto, 41, said the challenges they faced were in stark contrast to when she was volunteering at a mass vaccination site at the Portland Convention Center, which was staffed by hundreds of National Guard members and other volunteers. He said it was.
“I still vividly remember this incredible sense of urgency,” Kast said. “It’s amazing how, two and a half years later, it turned into, ‘Oh, the first few days I don’t know anything and it’s no big deal.'”
Customers at some Atlanta-area Publix pharmacies will not be able to receive the coronavirus vaccine if they have a Humana or United Healthcare insurance plan, according to a pharmacist who was not authorized to speak publicly. He was told that he needed prior approval. A United Healthcare spokesperson said no prior approval was required. Spokespeople for Publix and Humana did not comment on the situation.
Zachary Levenson had trouble getting vaccinated in Miami because the pharmacy couldn’t verify his insurance information. He then called his insurance company, Florida Blue’s hotline, and a customer service representative told him the vaccine was not covered. Pharmacists can instead direct people without health insurance to receive the vaccine for free by enrolling in a program that provides the vaccine free of charge, thereby avoiding rejection by people with health insurance. He said there was.
“What kind of country do I live in that this public health emergency has been going on for years and something as basic as a vaccine is not available in one of the largest cities in the country? ” said Levenson, 40, a professor of sociology.
In a statement to the Post, Florida Blue acknowledged that members may have experienced issues when the system was updated to incorporate the coronavirus vaccine, but pharmacies and beneficiaries will not be responsible for the cost. He said there is a possibility of a refund.
Vaccine advocates say Americans shouldn’t give up even if they’re asked to pay for the latest coronavirus vaccines.
“I think things will get better in the coming weeks,” said Amy Pisani, executive director of the vaccine advocacy group Vaccinate Your Family. “We’re solving a national problem, so we really hope people will circle it on their calendar and say come back in two weeks.”
The Sun reported from Atlanta.