Here’s what the federal government is telling insurers about covering the cost of COVID-19 shots
Thousands of claims being denied daily despite ‘legal obligations,’ U.S. Health and Human Services secretary says
Insurance companies around the country are being reminded of their legal obligation to cover the cost of the new COVID-19 vaccine now that the federal government is no longer picking up the tab for the shots.
Amid reports of some insured Americans being denied coverage or charged as much as $200 for the updated shots, U.S. Health and Human Services Secretary Xavier Becerra has issued a public statement directed at “the health care payer community.”
“With claims rejections in the thousands each day, we are missing opportunities to save lives together,” Becerra wrote in the statement posted Friday, telling payers, “we should be completely aligned in our goals of getting everyone the updated COVID-19 vaccine.”
Reports of problems with insurance coverage started the same week the new shots got the go-ahead for everyone 6 months and older, despite more than a year of efforts “to ensure a smooth transition” from federal government distribution of the vaccine, Becerra said.
He pointed out payers have been told repeatedly about “the requirement for most plans and issuers to cover the updated COVID-19 vaccines from Pfizer and Moderna without cost sharing,” which took effect when the shots were approved two weeks ago.
“Unfortunately, some consumers are experiencing insurance coverage denials when seeking the updated COVID-19 vaccines, and I am writing to ask for continued partnership and also want to remind you of legal obligations for coverage of the vaccines,” Becerra said.
Citing the Centers for Disease Control and Prevention, the secretary said “for every 10,000 vaccinations given to people 65 and over last winter, about 40 hospitalizations are prevented.”
The CDC’s COVID-19 “severity indictors” continuing to rise, with hospitalizations up nearly 8%, to more than 20,500 nationwide, for the week ending Sept. 9, and deaths climbing 12.5% for the week ending Sept. 16.
The Utah Department of Health and Human Services said seven new deaths from COVID-19 had been reported in the state during the week that ended last Thursday. That’s the highest number of weekly deaths from the virus since nine lives were lost in May.
Despite what’s been seen as a “dramatic” increase in COVID-19, the new shots were already expected to be a tough sell since only 17% of Americans have rolled up their sleeves for the previous vaccine update, a booster dose released more than a year ago.
The latest shots that target a newer version of the virus were approved by the U.S. Food and Drug Administration on Sept. 11 and by the CDC a day later, and were supposed to be available as soon as the end of that week.
But the rollout of the vaccine, the first since the federal government ended the national pandemic emergency, has been anything but smooth. There have been issues with supply as well as insurance coverage.
The situation is frustrating, Han Kim, a professor of public health at Westminster University in Salt Lake City, recently told the Deseret News, but Utahns should still take advantage of “a very easy way” to protect themselves against COVID-19.
“Wait a week or so until all this stuff gets smoothed out,” the professor advised. “I think the more people that get the vaccine, the less of a surge we’re going to see this fall and winter.”