There have been delays in health insurance coverage for some patients, which has slowed down the deployment of a fresh round of Covid vaccinations in the U.S.
The new Pfizer vaccines must be covered by private insurance plans as well as public health programs like Medicare.
both Moderna
which was released late last week. All Americans aged 6 months and older are advised to receive the latest round of immunizations by U.S. regulators.
The temporary coverage delays were confirmed by the Centers for Medicare & Medicaid Services, a few private healthcare organizations, and CVS, who also stressed that Americans can obtain Covid vaccinations at no cost through insurance programs. They claimed that some insurers are still attempting to amend their plans to include the new vaccines, which is the cause of the delays.
Numerous recent social media posts reveal that some patients were recently charged between $125 and $190 at pharmacies for a shot. Others were informed that the new immunizations are not yet covered by their insurance policies.
Even though public health officials have told insured patients that they can, the reports are fueling doubt among them about whether they can continue obtain Covid shots for free as cases spread across the nation.
Additionally, it follows a significant change in how Covid vaccinations are covered in the US.
As the government transitions vaccinations to the commercial sector, producers will now directly promote their new vaccinations to healthcare professionals for more than $120 a dose. Previously, the federal government obtained Covid vaccinations at a reduced price straight from producers to give out to all Americans.
An official with the CMS stated that the organization is "aware that some consumers have had difficulty accessing COVID-19 vaccines, including experiencing unexpected insurance coverage denials at the point of service."
In order to make sure that their systems are "up-to-date and prepared to meet their obligations to provide coverage of Covid-19 vaccines for participants, beneficiaries, and enrollees," CMS has been in "close contact with the plans about these transitions for months," and is now making another attempt.
According to a CVS representative speaking to CNBC, certain payers "are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines." They said that if a patient's insurance is rejected, the pharmacy teams at the business can assist in setting up a later appointment for a vaccination.
The owner of a jewelry company in Florida named Sarah Lindsey asked her own insurer to include the new Covid injections in its formulary.
Any covered member attempting to purchase it from a pharmacy is informed that it has not been approved and would cost $155 instead. There is no justification for this, she wrote in a post on X, formerly known as Twitter, on Monday. She named Florida Blue, a nearby Blue Cross Blue Shield provider.
A Florida Blue representative claimed that while a "small percentage" of patients had coverage concerns, the insurer does provide free vaccinations for the majority of beneficiaries. Patients with insurance who were charged for a Covid shot should get in touch with their pharmacist to request a refund or submit a claim to Florida Blue.
Meanwhile, a representative for the healthcare organization Elevance Health
requested that Covid vaccination claims be submitted again "so they can be processed at a $0 copay." They continued by saying that they anticipate the coverage delays to be rapidly remedied.
The coverage gaffes coincide with worries that the new vaccines, which are intended to target the omicron subvariant XBB.1.5, won't be widely adopted due to a combination of pandemic fatigue, the notion that Covid is "over," and confusion about individual risk thresholds.
The Centers for Disease Control and Prevention report that since Pfizer and Moderna's bivalent Covid boosters were approved in September, only 17% of Americans, or around 56 million people, have received them.
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