PHILADELPHIA – As Americans roll up their sleeves to get the latest COVID booster shot, some are being asked to pay out of pocket.
There are heated discussions on this topic on social media.
“I’m trying to get my COVID booster shot this month, but my insurance won’t cover the cost. So that’s fun.” read a post.
“PSA: Despite having an appointment, despite being in the right place at the right time, despite having insurance, I was unable to get my COVID booster shot today.” read another.
To clean up this mess, Action News turned to the insurance companies, the pharmacies and the federal government.
The Troubleshooters received an email on Thursday that read: “My son went to CVS on Saturday to get his COVID booster shot and was turned away saying he had to pay $200.”
Action News asked U.S. Assistant Secretary for Preparedness and Response Dawn O’Connell if insurance is not yet paying for the vaccine.
“Well, insurers are responsible for covering the new costs associated with the new vaccine. The department is working closely with insurers and pharmacies to ensure that the small glitches we see are resolved as quickly as possible,” O’Connell said.
The problem solvers turned to insurance companies and pharmacies, and some blamed each other.
For example, CVS responded: “Some payers (i.e. insurance companies) are still in the process of updating their systems… In this case, our pharmacy teams can help patients schedule an appointment for a later date.”
CIGNA Healthcare said it updated its systems with the new codes nearly two weeks ago, but some pharmacies are submitting claims incorrectly.
Independence Blue Cross said: “We are aware of the unexpected delay in coding. As of Tuesday, September 19, the delay has been resolved and pharmacies can bill Independence directly.”
The bottom line is that your COVID boosters should be covered. If your claim is denied at the pharmacy, contact your insurer for reimbursement and make sure you are at a pharmacy covered by your plan.
“We want to make sure you go to an in-network provider to get your vaccine, and that’s going to clear some things up over time,” O’Connell said.
There is also one Bridge program for the underinsured or uninsured.
You can also order free COVID test kits by the government from Monday, September 25th.
Delivery of the kits will begin a week later.
Blue Cross Declaration of Independence
Dr. Richard Snyder, vice president of Facilitated Health Networks
We know that COVID-19 vaccines and boosters are important tools to help reduce the risk of serious illness, hospitalization and death. That’s why Independence Blue Cross’s COVID-19 vaccination and booster shots are covered free of charge for individual and group members when obtained through an in-network provider or pharmacy. If a COVID-19 vaccination or booster dose is administered by an out-of-network provider or pharmacy, a standard cost-sharing fee will be applied based on a member’s health plan benefits. We encourage members to review their benefits to learn about in-network providers and see if they have out-of-network coverage.
For Medicare Advantage members, COVID-19 vaccination and booster vaccination coverage is covered as a preventive benefit under Part B. For CHIP members, COVID-19 vaccination and booster vaccination coverage is covered free of charge as a preventive service.
We are aware of the unexpected delay in coding to enable payment for the updated COVID-19 vaccine, which has resulted in some members being informed that the vaccine is not covered by their health insurance. This impacts most health insurers covering the vaccine. As of Tuesday, September 19, the delay has been resolved by the relevant parties and pharmacies are able to bill Independence directly for the pharmacy service.
Independence members who paid out-of-pocket for the vaccine can request a refund.
Cigna Healthcare Statement
For Cigna Healthcare customers, COVID vaccines are covered free of charge at any in-network pharmacy or doctor’s office.
Rite Aid Statement
The new COVID-19 vaccine is expected to be commercially available this weekend. Customers can schedule appointments through our online scheduler at riteaid.com/pharmacy/scheduler or go to their local Rite Aid to see if the vaccine is available.
Some payers are still updating their systems and may not yet be prepared to cover the updated COVID-19 vaccines. In this case, our pharmacy teams can help patients arrange an appointment for a later date.
American Health Insurance Plans Statement
The U.S. Food and Drug Administration (FDA) recently approved and the Centers for Disease Control and Prevention (CDC) has recommended updated COVID-19 vaccines for everyone ages 6 months and older. Health insurance companies understand the importance of these vaccinations and continue to encourage everyone to get vaccinated against COVID-19.
AHIP members will receive coverage for the new COVID-19 vaccinations at no cost when received through an in-network provider. We are working closely with the federal government, pharmacies and other partners to quickly ensure patient access to COVID-19 vaccines at $0 cost-sharing and to quickly resolve any issues related to newly added billing codes.
We are committed to ensuring that no patient pays and everyone who is eligible and wants a vaccine receives one. COVID-19 vaccines will continue to be available to the public at no cost. The costs are covered either by insurance or government assistance programs such as the CDC’s Bridge Access Program. Our pharmacists are familiar with insurance claims processing procedures and can assist with questions. We encourage everyone to bring insurance information to their appointment if available, but will not turn away those whose insurance does not cover it.
Vaccinations for children ages 3 to 11 will be available at select Walgreens locations starting as early as September 29th. Appointments will be continually added as this supply arrives at our locations. Parents or guardians are strongly encouraged to schedule appointments for this age group to ensure the best experience by visiting Walgreens.com/ScheduleVaccine, using the Walgreens app or calling 1-800-WALGREENS. We offer flexible hours, including nights and weekends, and the ability to schedule multiple vaccinations for multiple people in your family during the same visit.