COVID-19 vaccine bill surprises some
Here’s why and what you should do about it
The latest round of updated COVID-19 shots just rolled out in the U.S. But some people are getting a bill of nearly $200 for a vaccine that’s supposed to be free.
Here’s why and what you can do if that happens to you.
People across the country have posted on social media about surprise charges for the shots, ranging from $125 to $190.
“This should be resolved very quickly as health plans and pharmacies get billing codes in place,” Karyne Jones, president and CEO of the National Caucus and Center on Black Aging, said in a statement. That nonprofit is one of three conveners of the COVID19 Vaccine Education and Equity Project.
“Consumers shouldn’t be paying out-of-pocket and should know to push back if anyone tries to charge them,” Jones said.
What’s new with vaccines?
Hospitalizations for COVID-19 are on the rise, according to data from the U.S. Centers for Disease Control and Prevention, though they are still significantly lower than what was seen during peak pandemic times.
This fall the Food and Drug Administration approved updated vaccines. The CDC recommended the new shots for everyone over 6 months of age.
The shots are now commercialized, meaning the new commercial cost is over four times as expensive. Previously, the federal government spent billions to buy vaccines to provide for free to everyone. Manufacturers indicated they would charge between $110 to $130 per single-dose vial.
That price tag wasn’t supposed to affect consumers. Vaccines are available to just about anyone, regardless of their insurance.
Most public or private insurers are required to cover vaccines, which remain the “best protection against COVID-19-related hospitalization and death,” according to the CDC. Medicare and Medicaid also cover the vaccines.
If you’re one of the 25 to 30 million adults without insurance, you can still get a free vaccine from local health centers or pharmacies through the CDC’s Bridge Access Program.
What’s changing now?
The Centers for Medicare & Medicaid Services and CVS confirmed to CNBC and CBS Boston that there have been temporary delays in coverage as some insurers update their plans with the new vaccines. McClatchy News reached out to CMS, was directed to reach out to the Department of Health & Human Services and has not received a response.
CVS and CMS said a new billing code for insurances led to the problem charges, CBS Boston reported.
A spokesperson for CVS told McClatchy in a statement that, “Some payers are still updating their systems and may not yet be set up to cover the updated COVID19 vaccines.
A spokesperson for CMS told CNBC that the agency is “aware that some consumers have had difficulty accessing COVID-19 vaccines, including experiencing unexpected insurance coverage denials at the point of service.”
What can you do?
The pharmacy teams at CVS can help you reschedule a vaccine appointment if your coverage is denied. Florida Blue, a local Blue Cross Blue Shield insurer, told CNBC that any insured patients who were charged should get in touch with their pharmacy for reimbursement or file a claim.
Another health care provider, Elevance Health, told CNBC that pharmacies should resubmit COVID-19 vaccine claims.
You should take these steps if you got a bill for a vaccine, according to Medicare.Gov:
Check the receipts and statements from your provider for mistakes.
Call your provider to ask about incorrect charges.
If you have Original Medicare, review your “Medicare Summary Notice” for errors. If something looks suspicious, report it to Medicare by calling 800-633-4227.
For other coverage such as a Medicare Advantage Plan, review your Explanation of Benefits and report anything suspicious to your insurer.
If you think you were incorrectly charged, ask the provider for a refund.
If you think the provider charged you for another fee or for an office visit, but you only got a COVID-19 vaccine, you can report them to Office of the Inspector General, U.S. Department of Health and Human Services by calling 800-HHS-TIPS or visiting TIPS.HHS.GOV.