Americans billed for COVID-19 vaccine despite having insurance.
Insured Americans Charged Over $100 for COVID-19 Vaccines as Insurers Fail to Update Plans
Insured Americans are being charged more than $100 for the newly rolled-out COVID-19 vaccines as insurers fail to update their plans, with some people deciding against taking the jab after learning about the cost.
Several posts on social media have claimed that people have been charged for a shot of the new vaccine at pharmacies.
“Hey @FLBlue: do your job and add the new, long-awaited Covid-19 vaccine to your pharmaceutical formulary. Any insured member trying to get it at a pharmacy is being told it’s not approved and will cost $155. There’s no excuse for this,” Sarah Lindsey, a jewelry store owner from Florida, wrote in a Sept. 19 post on X, formerly known as Twitter. “FLBlue” refers to Florida Blue, the name under which Blue Cross and Blue Shield of Florida does business and offers health insurance plans.
Glen Cote from Acton, Massachusetts, received a text on his phone saying that his COVID-19 shot would cost $190.99, according to WBZ-TV. The message came just before his appointment at retail pharmacy chain CVS to receive the new vaccine. Mr. Cote, who’s covered by the state Medicaid program MassHealth, went on to cancel the appointment.
According to the Centers for Medicare and Medicaid Services (CMS) and CVS, the new COVID-19 vaccines have a revised billing code for insurers, which the firms are yet to update for their plans. That’s led to many people being wrongfully charged for the shot.
“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,” a CVS spokesperson stated, according to CBS News.
The COVID-19 public health emergency (PHE) ended in May. During the COVID-19 PHE, the federal government purchased the vaccines at a discount from manufacturers and distributed them to U.S. residents for free. With its end, the shots have been moved to the commercial market.
In a statement to The Hill, America’s Health Insurance Plans (AHIP)—a trade association of insurance firms—said that insurance providers “are working with the federal government and pharmacy and provider partners to ensure that everyone has access to [Advisory Committee on Immunization Practices]-recommended vaccines, without cost sharing.”
“The new vaccine formulations mark the first time that the COVID-19 vaccines are available without being purchased/distributed by the federal government,” the statement reads, according to The Hill.
With the end of the COVID-19 PHE, individuals without health insurance can now access free COVID-19 vaccines only through the U.S. Centers for Disease Control and Prevention’s (CDC) Bridge Access Program.
The initiative “provides no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. No-cost COVID-19 vaccines through this program will be available until December 31, 2024.”
The CDC estimates that there are 25 million to 30 million U.S. adults without health insurance.
Speaking to reporters on Sept. 20, Health and Human Services Secretary Xavier Becerra said that the Bridge Access Program is “a billion-plus dollar program” and pointed out that the CDC will be paying a similar price for the vaccine as it did in the past.
During the first round of vaccinations, the federal government had paid $20 per dose. The new vaccines on the commercial market exceed $100 a dose, with Pfizer charging $120 and Moderna charging $129 per shot.
“You don’t have to pay out of pocket for your vaccine. But it is not … it’s not cost-free. There are costs to making a vaccine available,” Mr. Becerra said, according to The Hill.
Vaccine Risks
The new COVID-19 vaccines from Pfizer and Moderna were approved by the U.S. Food and Drug Administration (FDA) on Sept. 11, with the shots made available for use among U.S. residents as young as 6 months old.
Dr. Peter Marks, a top FDA official, has insisted that vaccination is “critical” for protecting against COVID-19 hospitalization and death.
However, many critics, including experts, have come forth with recommendations advising against taking the vaccine.
The Florida Department of Health issued a warning against the new vaccines on Sept. 13. In its guidance (pdf), it pointed out that “the most recent booster approval was granted in the absence of any meaningful booster-specific clinical trial data performed in humans.”
“Based on the high rate of global immunity and currently available data, the State Surgeon General recommends against the COVID-19 booster for individuals under 65. Individuals 65 and older should discuss this information with their health care provider, including potential concerns outlined in this guidance.”
The department pointed out that mRNA vaccines pose a risk of clinical myocarditis and cardiovascular issues among “otherwise healthy individuals” and that there’s an “unknown risk of potential adverse impacts” with each additional shot of mRNA COVID-19 vaccines.
The spike protein in these vaccines may persist among some individuals “for an indefinite period of time,” posing health risks.
The department noted that several studies have found mRNA COVID-19 vaccines to be associated with “negative effectiveness” after four to six months.
“As efficacy waned, studies showed that COVID-19-vaccinated individuals developed an increased risk for infection. This is not found in other vaccines, including the flu vaccine.”
A new study funded by Pfizer found that the company’s COVID-19 vaccine didn’t perform well in children younger than 5 years old.
Children ages 6 months to 4 years old are supposed to receive three shots of the Pfizer-BioNTech vaccine. The dosage was increased from two shots when early testing showed little effectiveness.
Three doses of the Pfizer vaccine provided little protection against emergency room visits, urgent care encounters, or outpatient visits, according to the new study.
Pfizer’s vaccine was authorized for children despite unreliable efficacy estimates against infection, and no efficacy estimates against severe disease.
What risks does the failure of insurers to update their plans and billing codes for the vaccine pose to public health?
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This issue has caused frustration and concern among insured Americans who were expecting the COVID-19 vaccine to be covered by their insurance plans. Many people have shared their experiences on social media, expressing their disappointment and disbelief at being charged such high amounts for a necessary vaccine.
The failure of insurers to update their plans and billing codes for the COVID-19 vaccines has also led to individuals hesitating or deciding against getting the vaccine altogether. The unexpected cost of over $100 has become a deterrent for some people who cannot afford to pay that amount out of pocket. This poses a risk to public health as it hinders the vaccination efforts and slows down the progress in controlling the spread of the virus.
While some insurance companies have resolved the issue and updated their plans, many others are still in the process of doing so. The Centers for Medicare and Medicaid Services and CVS have acknowledged the problem and urged patients to reach out to their pharmacy teams for assistance in scheduling appointments for a later date.
It is crucial for insurance companies to promptly update their plans and billing codes to ensure that the COVID-19 vaccines are fully covered for insured individuals. The vaccine is a vital tool in the fight against the ongoing pandemic, and everyone should have equal access to it without any financial obstacles.
Additionally, transparency and clear communication between insurers, pharmacies, and individuals are essential to avoid confusion and prevent unnecessary charges. Insured Americans should be informed about the coverage of the COVID-19 vaccine under their plans and any updates or changes in billing codes to avoid any surprises or misunderstandings.
In the current situation, where the vaccination efforts are crucial for public health and safety, it is imperative that all parties involved take immediate action to resolve this issue. Insurers need to prioritize updating their plans, and pharmacies should ensure accurate billing and communication with their patients. Together, we can overcome this challenge and ensure that COVID-19 vaccines are accessible and affordable for all insured individuals.
Ultimately, the goal is to protect the health and well-being of Americans and achieve a high vaccination rate to bring an end to the COVID-19 pandemic. It is essential that insurance companies fulfill their responsibility and promptly update their plans, so insured Americans can receive the vaccine without any financial burden. By doing so, we can move forward towards a safer and healthier future for everyone.
" Conservative News Daily does not always share or support the views and opinions expressed here; they are just those of the writer."
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