Insurance companies deny COVID booster to thousands of people every day. What to know

Roll out of the new COVID-19 booster shots is off to a bumpy start as people across the country are being denied coverage for the shot by health insurance providers.

In an open letter to the “health care payer community” on Sept. 22, Xavier Becerra, secretary of the U.S. Department of Health and Human Services, asks health care providers to honor their “legal obligations for coverage of the vaccines.”

Three years after the start of the pandemic, fall 2023 marks the first season COVID-19 vaccines are being distributed through what Becerra called “traditional health care distribution channels.”

Previously, the federal government bought and then distributed the vaccines and boosters for free, but now the distribution is up to the commercial market, including pharmacies like CVS and Walgreens.

The new booster shots were approved by the Food and Drug Administration on Sept. 11 and recommendations by the Centers for Disease Control and Prevention were updated on Sept. 12.

The CDC now recommends everyone 6 months and older receive an updated booster.

Why are people being denied COVID boosters?

Within a week of the new booster’s approval, many people across the country tried to make an appointment only to be told it would not be covered by their insurance.

Becerra wrote in his letter that providers had been alerted to their required coverage by the Centers for Medicare and Medicaid Services back in July, but when HHS started receiving reports of shot denials, he reached out to providers again on Sept. 20.

“Since that time, I know my team – including CMS – has been in close contact with you, now on a daily basis,” Becerra wrote. “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 are resolved.”

Despite the repeated reminders, Becerra said claim rejections are in the “thousands each day.”

In a statement to KATU, CVS spokesperson Matt Blanchette said stores were receiving the vaccines from Pfizer and Moderna on a “rolling basis,” and insurance providers couldn’t keep up.

“...The majority of our locations are able to honor scheduled appointments. However, due to delivery delays to select stores, some appointments may be rescheduled. We’ll continue to offer additional appointments at those locations as supply is received,” Blanchette told the outlet. “Separately, 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.”

Without insurance coverage, the boosters can range in price from $100 to $200 with additional administration fees, CNN reported.

“It is critical to help your members navigate your network, particularly to help people understand the differences between your medical and pharmacy network as appropriate,” Becerra wrote. “We know you are already looking for ways to smooth these issues and hope that will continue. In the meantime, we will do our part to urge consumers to seek in-network providers when possible.”

Do I need a COVID-19 booster shot?

The new COVID-19 booster shots became available as omicron sub-variants are causing cases and hospitalizations to spike this fall.

The new formula addresses the most common variants, with the CDC recommending it for everyone 6 months and older. The updated vaccine formula is available from Pfizer, Moderna, Novavax and Janssen.

Specifically, children ages 6 months to 4 years who are unvaccinated should receive two or three doses of the mRNA vaccine from the same manufacturer, including the new formula, the CDC says.

Children ages 6 months to 4 years who previously received a full vaccine series, including one or two shots and a booster, should receive the new booster, according to the CDC.

People over the age of 5 who are unvaccinated or received the original COVID-19 shot and booster should receive the new booster, the agency said.

If you are over the age of 12 and received the Novavax vaccine or the Janssen vaccine, the CDC recommends you receive an updated booster from the same manufacturer.

Any booster should be given at least two months after a previous vaccine or booster.

Where can I get the new COVID-19 booster?

The new vaccines are now available at participating pharmacies and clinics. You can find a location offering the new booster by going to vaccines.gov and selecting your specific vaccine manufacturer.

Some pharmacy locations have not yet received the new doses, so it’s important to contact your local pharmacy to confirm the shots are available before making an appointment.

Insurance providers are required to cover the cost of the vaccine, according to the HHS, but it’s important to reach out to your specific provider about your coverage before receiving the shot.

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