The updated COVID-19 vaccine is supposed to be free to patients in almost all cases, but problems with payment systems are causing some people who have health coverage to be incorrectly charged hundreds of dollars.
Some patients are being told the shot is not covered by insurance and asked to pay fees up to $200 even though insurers are required to cover the shots.
Any patients with health insurance who have been asked to pay for their COVID-19 vaccine should seek reimbursement from their insurance carriers, according to the companies and the state Bureau of Insurance.
It’s unclear how many people in Maine and across the country have been wrongly charged out-of-pocket fees during the rollout of the new COVID vaccines. But the issue is widespread enough that federal officials have called on insurers nationwide to fix the problem, and both insurance carriers and pharmacies say it has been happening to patients in Maine.
Insurance carriers have blamed a coding “glitch” for the problem and said they are working to correct it, if it hasn’t already been fixed. It’s unclear why it has been happening now, but didn’t during previous rounds of vaccine rollouts.
“Our members are covered in full for their COVID vaccines and boosters,” Kathleen Makela, spokeswoman for Harvard Pilgrim Health Care, said in an email response to questions. “We have heard anecdotally that some members are having issues at the point of sale due to coding issues. The newly approved updated vaccines were coded in our systems last week.”
Makela said any Harvard Pilgrim members who paid are encouraged to contact the insurance company and they will be reimbursed.
Stephanie DuBois, spokeswoman for Anthem insurance, said the vaccine should be free, but “due to tight turnaround times to update payment systems, a small number of claims were denied in the first couple of days the vaccine was available. That was resolved last week and pharmacies should resubmit any denied claims so they can be processed at a $0 co-pay. If a member went to a pharmacy recently and coverage was denied or they were unable to receive the vaccine, they can return to receive it at a $0 co-pay. If a member paid out of pocket, they can call member services on the back of their Anthem ID card for assistance with reimbursement.”
Federal officials have reminded insurance companies they are legally required to cover the vaccines and urged them to correct the problem quickly.
A Sept. 20 letter to insurance carriers from Xavier Becerra, U.S. Health and Human Services secretary, reminded them that the “requirement for most plans and issuers to cover the updated COVID-19 vaccines from Pfizer and Moderna without cost sharing became effective immediately upon FDA authorization.”
Becerra’s letter also said the insurance carriers are not entirely to blame, although it doesn’t go into detail about what is causing the problem.
“I also know that parts of these challenges are beyond your control. We will continue to be in daily communication with pharmacies and pharmacy benefit managers until these problems get resolved,” he wrote. “But some of these issues may be within your control, or the control of your partners. ”
CVS spokeswoman Tara Burke said that “some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines. If this happens, our pharmacy teams can help patients schedule an appointment for a later date.”
Maine-based Community Pharmacies, which has limited supplies of the vaccine, has had two patients run into trouble getting insurance coverage for the vaccines, said Amelia Arnold, the pharmacy’s operations manager.
INSURERS MUST COVER VACCINES
Judith Watters, spokeswoman for the Maine Bureau of Insurance, said Maine insurers “must cover COVID-19 vaccinations without cost-sharing, but individuals should make sure they go to an in-network provider.” There could be out-of-pocket fees for out-of-network providers.
Watters said if patients are asked to pay for the COVID-19 vaccine, they should contact their insurer, and if the issue is not resolved, they can file a complaint with the bureau. The bureau had not received any complaints as of Tuesday.
The updated shot was approved by federal regulators on Sept. 12. The new vaccines are formulated to be more effective against subvariants of the virus that are currently circulating.
The vast majority of Maine residents are insured through private carriers or by Medicare or Medicaid. Uninsured patients also can get free vaccines at retail pharmacies such as CVS and Walgreens and other participating providers through the federal Bridge Access Program.
Appointments for the shots are still difficult to get because supplies of Pfizer and Moderna vaccines have been limited in Maine and nationwide. More doses are expected to be available in the coming weeks.
Maine and other states have experienced increasing rates of COVID infections in the past six weeks that have been driven by the latest variants. Hospitalizations also have edged higher, with 62 people in Maine hospitals testing positive Tuesday, including 10 in critical care. Forty-two Maine hospital patients had tested positive on Aug. 1, including five in critical care.
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