Some consumers trying to get the latest coronavirus vaccines this week encountered red tape, canceled appointments or delays in obtaining private insurance to cover vaccinations. There are some too.
Major disruptions occur amid systemic change., Because the federal government is not paying for or distributing all the COVID-19 vaccines. Public and private health insurance providers must pay the full cost of the injections, as well as administrative fees. Uninsured patients can also receive free shots through a federal program. In response to the rising number of cases, the Biden administration on Monday announced plans to restart another federal program that allows consumers to order four free tests per household.
Millions of doses of the latest Pfizer-BioNTech and Moderna vaccines have been shipped to pharmacies and clinics since the U.S. Centers for Disease Control and Prevention approved the new version. The agency recommends that everyone six months of age and older receive an up-to-date vaccination against recent variants of the virus that causes COVID-19.
Chain pharmacies are busy vaccinating customers, but it’s stressful for many people who want to get vaccinated.Dozens of people turned their heads Social media To share stories of insurance company roadblocks, delayed appointments, and out-of-network denials.
Experts say the market will undoubtedly be disrupted by shifting such a large-scale vaccine rollout from governments to private insurers.
“This is very similar to the patchwork nature of the U.S. health care system,” said Sabrina Corlett, founder and co-director of the Center on Health Insurance Reform at Georgetown University’s McCourt School of Public Policy.
“It’s very difficult to be responsible.”
Patrick Dye of Vienna, Virginia, started calling new vaccinations as soon as they became available, but he hit one roadblock after another.
When he learned his doctor’s office didn’t have the vaccine, he contacted his insurance company, Anthem Blue Cross Blue Shield, to ask about his options. The insurance company told him he would only be covered if he received the vaccine from a “health care provider” or doctor, but the doctor had already told him that his office did not have the latest vaccines. It is said that he was
In total, Ms. Dye called her doctor, her insurance company, the hospital clinic affiliated with her doctor, Walgreens, and an independent pharmacy more than six times in total. He was finally able to get the shot Friday at a CVS pharmacy. The situation is complicated by the fact that he has a low-deductible, pre-Affordable Care Act health insurance plan known as a grand plan that operates under different rules than ACA plans. He said that it has become.
Still, he said consumers shouldn’t have to struggle too hard to get vaccinated to protect themselves and others.
“It’s very difficult to take responsibility,” Dye said.
Health experts struggle with vaccinations
Cynthia Cox, vice president and ACA director at the Health Policy Foundation KFF, is well versed in the nuances of the health insurance industry and the U.S. health care system.
However, even she struggled to make timely shots.
She tried to get vaccinated on Tuesday ahead of a trip next week, but pharmacies in her health insurance company’s network didn’t have the vaccine in stock.
she was willing to pay The $200 was paid out of pocket at a Walgreens pharmacy in the Washington, D.C. area, which was not part of her insurance company’s network. When she tried to do so, a Walgreens employee contacted her insurance company, who informed Cox that she needed prior authorization to receive the vaccine outside of the network. . The insurance company required Cox to track down her doctor’s fax number as part of the process.
End result – Cox didn’t get the shot, even though he was willing to pay out of pocket. She was unable to get an appointment at her local CVS store, and staff at the non-chain pharmacy said the vaccine wouldn’t be available until next week.
She searched her insurance company’s directory of in-network pharmacies that carried the vaccine and found one in Baltimore. “For the vast majority of people who live in and around Washington, D.C., that’s not a real solution,” she said.
“Even though I’ve been in the insurance policy business for over 10 years, at the end of the day, it was the insurance bureaucracy’s fault that I couldn’t get that insurance,” Cox said.
Biden administration, insurers vow to improve
Biden administration officials, health insurance companies and pharmacies have acknowledged confusion in the early stages of the rollout.
A spokesperson for the U.S. Department of Health and Human Services said the agency is aware that some vaccine seekers are receiving “unexpected denials of insurance coverage at the point of service.” The federal agency contacted insurance companies to ensure their computer systems are up to date and reminded them that they must cover the coronavirus vaccine at no cost to their insureds. For the uninsured, CDC’s “Bridge Access” Program I will pay for the vaccine.
In July, Centers for Medicare and Medicaid Services Administrator Chiquita Brooks Lasure sent a letter It urged insurance companies to update their systems by mid-to-late September in preparation for the release of vaccines.
James Swan, a spokesman for America’s Health Insurance Plans, an industry group representing large private health insurance companies, said health insurance companies will cover the entire cost “if you obtain the vaccine through an in-network provider.” He said it would happen. He said insurers are working with pharmacies and others to “provide patients with rapid access to the COVID-19 vaccine at no cost-sharing and quickly address issues related to newly added billing codes.” he added.
CVS spokesman Matt Blanchett said some insurers’ systems are not yet set up to cover the latest vaccines. In these cases, the consumer can pay with cash or have the pharmacy technician reschedule the appointment.
CVS stores have been administering the latest coronavirus vaccinations since last week, and shipments of vaccinations continue to arrive. Blanchett said consumers can check CVS.com to see if a store has vaccinations available and to make an appointment.
A Walgreens spokesperson said the pharmacy is “committed to ensuring that all eligible people who wish to receive the vaccine receive it at no cost to our patients.”
Consumers scramble for shots
Joe Anderson Jr., 36, a clinic director in Austin, was scheduled to attend Beyoncé’s highly anticipated tour in New Orleans next week. To be on the safe side, he wanted to get a COVID-19 booster, even though full protection wouldn’t be available until after his week.
He found there was little information about boosters on city, county and federal government websites, as well as on his private insurance portal and major retailers like CVS and Walgreens. On Wednesday night, he received a call from a Walgreens representative telling him that his appointment for the next day had been canceled, leaving him scrambling to secure another vaccine in the Austin area.
Thursday afternoon, he found an appointment at Walgreens, but wasn’t sure if his insurance would cover it. But when he showed up for the injection, the pharmacy didn’t ask him to pay any copays. He then arranged to meet his mother in Dallas on Friday.
It took a little effort and a little luck to find commitment, but his persistence paid off.
“I feel like I have to ask them,” he said. “And it’s really reactionary, not proactive.”
The number of people infected with the new coronavirus and the number of tests are on the rise
The new vaccines arrive as coronavirus infections continue to rise since early July, but infection rates remain well below previous peaks. Hospital admissions rose 7.7% in the week ending September 7, and coronavirus deaths rose. 12.5% for week ending September 16thbut the total remains lower than during the previous rise.
Another indicator that has public health officials concerned is that the percentage of people testing positive for the coronavirus has risen from about 4% in early June to more than 14% as of September 9. is. CDC testing data typically does not include at-home coronavirus tests unless someone visits a hospital. A doctor who orders a test through a laboratory.
Consumers can request four free coronavirus home tests per household through a government-run website starting Monday. CovidTests.gov. The federal government will give $600 million to more than a dozen domestic coronavirus test manufacturers to shore up the government’s supply of these tests. The availability comes as chain retailers report regular shortages of home tests.
