COVID vaccine insurance problems persist; some patients told no coverage yet
Pharmacist Aaron Sun administers the new COVID-19 vaccine by Pfizer to Jimmy Smagula at CVS Pharmacy in Eagle Rock, California, on Thursday. Credit: TNS/Irfan Khan
Long Islanders continue to face problems in getting insurance coverage for the new COVID-19 vaccine, as one insurer puts partial blame on pharmacies and a pharmacy chain points the finger at insurance companies.
Bonnie Bernstein, 61, of Sea Cliff, who has Medicaid, said a pharmacist at a CVS in Sea Cliff told her on Sunday that a vaccine would cost her $190 because Medicaid coverage was not going through. She said she called Monday and was told the store was not administering any vaccines for the next few days and was told to try back at the end of the week.
“I’m high-risk, so I wasn’t very happy about this,” she said.
Bernstein has Parkinson’s disease, and that puts her at higher risk for COVID-19 complications and a more difficult recovery, according to the Parkinson’s Foundation.
The Affordable Care Act, commonly known as Obamacare, mandates in-network insurance coverage of vaccines recommended by the Centers for Disease Control and Prevention without copays. The CDC on Sept. 12 recommended the new COVID-19 vaccine for anyone 6 months and older.
Medicare and Medicaid must also cover the vaccine without copays.
Yet some people who turned up at pharmacies for their vaccine appointments have been told over the past few days that their insurance companies won’t cover the shots yet.
CVS spokeswoman Tara Burke Monday reiterated a statement from Friday that “some payers are still updating their systems and may not yet be set up to cover updated COVID-19 vaccines.”
She didn’t respond to questions about whether any CVS locations temporarily suspended administration of the vaccines because of insurance issues.
Jennifer Kates, a senior vice president at the San Francisco-based KFF, a health-policy nonprofit, predicted that problems would be resolved over time.
“I do think this is initial-rollout hiccups and challenges that will smooth out,” she said.
Kates said insurers are adjusting to the transition from the federal government paying for the vaccine to requiring insurance companies to do so.
“It’s incredibly fast for the commercialization of a product,” she said.
But, she said, insurance companies “knew this was coming.”
Leslie Moran, spokeswoman for the New York Health Plan Association, which represents insurers, said “systems updates are not always simple, and they require some time.”
She said most insurers in New York she has talked with “feel they’ve worked out any systems issues. There may be cases where it still persists, but they’re working very hard to get them resolved. They’re working with the pharmacies to make sure that if [policyholders] come in with their plan cards, the message they get is this will be covered.”
The issue sometimes is with pharmacies, a Cigna Healthcare spokesperson said in an email Monday.
“Some pharmacies are submitting the claims incorrectly, which is resulting in denials,” the statement says. “We are in touch with those pharmacies to help them resolve the issues in their submission process.”
Pharmacies say they will work with people who are having difficulty getting coverage for the vaccine.
“Our pharmacy teams can help patients schedule an appointment for a later date,” said Burke, from CVS.
Walgreens said in a statement that it “will not turn away those whose insurance does not cover it. Walgreens is committed to ensuring no patient pays.”
People for whom Walgreens is out of network will be referred to an in-network pharmacy, the company said. Walgreens participates in a federal program that provides vaccines to uninsured people, the statement said.
The New York Department of Financial Services, which regulates private insurance companies, said anyone with private insurance charged for a COVID-19 vaccine should contact the insurer to request a refund or credit, and, if the issue isn’t resolved, file a complaint with the DFS.
The Centers for Medicare and Medicaid Services Monday referred to a statement sent to Newsday on Friday, which said that CMS had updated its computer systems to handle the new vaccines.
David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.
