Untold numbers of New Yorkers have tried to get the new COVID-19 vaccines, only to learn they either must pay upwards of $120 out of pocket or reschedule the shot for a later day when health coverage is updated, according to CVS Health and some health plans.
Some health plans asserted on Monday that the coverage issue is being addressed, noting the new vaccines will be available without costs to consumers this week. Federal programs are covering the vaccine cost for the uninsured.
The early misstep comes amid concerns that a mix of pandemic fatigue and anti-vaccine misinformation would limit uptake of the new vaccines, which have proven effective at limiting severe illness from all COVID variants currently spreading. Just 15% of New Yorkers received a bivalent booster dose offered previously.
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What caused health coverage issue with new COVID vaccine?
Earlier versions of COVID-19 vaccines had been offered free of charge to Americans in part because the federal government used taxpayer dollars to buy the doses from drugmakers and distribute the vaccines nationally.
But the federal pandemic emergency declaration ended this past spring, cutting off the vaccine funding. Now, health insurance companies and government health programs such as Medicaid and Medicare are expected to cover the cost of COVID vaccines going forward.
Health insurers in New York received the computer coding necessary for making the change to cover new COVID vaccines late last week, resulting in some rescheduling of shot appointments on Friday, according to statements issued by the New York Health Plan Association.
Going forward, the new COVID vaccines should be covered by all health plans in New York as a preventive service without any cost sharing for consumers, the health insurance trade group noted.
The state Department of Health is aware that some consumers were mistakenly informed their insurance did not cover the vaccine cost, spokesperson Danielle De Souza noted Monday. “We encourage these consumers to contact their insurer immediately to request the reimbursement for which they are legally eligible,” she said.
Uninsured individuals or those whose insurance doesn’t cover the updated vaccine can still get the shots free of charge through community health centers; local, tribal, or territorial health departments; and pharmacies participating in the HHS’ Bridge Access Program, she added.
Stephanie DuBois, a spokesperson for Empire BlueCross BlueShield, issued a statement asserting the federal Centers for Disease Control and Prevention provided health plans with incorrect information about the vaccines arrival.
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“Due to timing issues, a small number of members’ claims rejected last week because pharmacies had access to the new COVID-19 vaccine early, and our system was prepared based on the CDC timeline communicated for availability of the vaccine,” DuBois said.
Those Empire claims are being re-processed, DeBois added, and its members will receive their vaccines at a $0 copay.
CDC didn’t immediately respond Monday to questions about the matter.
Where can I get new COVID-19 vaccine booster in NY?
New Yorkers can search online for vaccination providers in their community via vaccines.gov, or call the federal vaccine hotline at 1-800-232-0233. These search tools allow for finding shots for flu, COVID-19 and other illnesses.
Dr. Debi Johnson is a medical expert and health journalist dedicated to promoting well-being. With a background in medicine, she offers evidence-based insights into health trends and wellness practices. Beyond her reporting, Dr. Debi enjoys hiking, yoga, and empowering others to lead healthier lives.