Consumers who have been seeking updated versions of the COVID-19 vaccine have been encountering various obstacles this week, including red tape, appointment cancellations, and issues with insurance coverage. This comes as the responsibility for vaccine distribution and payment shifts from the federal government to public and private-sector health insurance providers. While uninsured patients can still receive free shots through a federal program, those with insurance are finding it difficult to navigate the system.
One consumer, Patrick Dye, faced numerous roadblocks in his quest to get vaccinated. His doctor’s office did not carry the updated vaccine, and his insurer informed him he would only be covered if he received the shot from his doctor or healthcare provider. Dye reached out to multiple healthcare professionals and pharmacies before finally getting vaccinated at a CVS pharmacy. His situation was further complicated by the fact that he had a pre-Affordable Care Act health insurance plan, which operates under different rules than ACA plans. Dye believes that consumers should not have to go through such difficulties to protect themselves and others.
Even health experts are struggling to get timely vaccinations. Cynthia Cox, a health expert, and director of the ACA at the health policy foundation KFF, had difficulties finding a vaccine at her insurer’s in-network pharmacies. She was willing to pay out of pocket at an out-of-network pharmacy but was told she needed prior authorization. Cox ultimately couldn’t get the shot, despite her extensive knowledge of the insurance industry.
The Biden administration, insurers, and pharmacies have acknowledged the challenges faced by consumers in the vaccination rollout. The U.S. Health and Human Services Department has reached out to insurers to ensure their computer systems are up to date and remind them of their obligation to cover COVID-19 vaccines without cost sharing for insured consumers. The Centers for Medicare & Medicaid Services has also urged insurers to update their systems to be ready for the vaccine’s release. Health insurers have committed to covering the full cost of the shot when obtained through a network provider. Pharmacies like CVS and Walgreens continue to receive shipments of the updated vaccines and are working to ensure patient access.
Consumers have been scrambling to find available vaccine appointments, with limited information available on official websites. Joe Anderson Jr., a health clinic director, needed a COVID-19 booster before attending an upcoming event but found it challenging to obtain one. He had to navigate various websites and eventually got an appointment at a Walgreens. Although he was unsure if his insurance would cover it, he didn’t have to pay anything out-of-pocket.
As COVID-19 cases continue to rise, it is crucial for individuals to have access to both vaccines and testing. The government has announced plans to restart a federal program that allows consumers to order four free tests per household. The availability of free home tests is particularly important as the share of positive COVID tests has been increasing. As the U.S. healthcare system transitions from government to private-sector insurers, there will inevitably be hiccups and challenges. However, efforts are being made to address these issues and ensure that individuals can access vaccination and testing services smoothly.