New Covid Vaccines Hit Insurance Snags: What to Do if Yours Gets Denied

Vero Lopez was excited about getting the new Covid vaccine. She’s cautious about the virus, still carrying a mask around and avoiding indoor dining. So Ms. Lopez, 52, contacted her health care provider, Kaiser Permanente, as soon as she found out the shots were approved last week. She couldn’t get the vaccine through them yet, but a CVS drugstore near her home in Los Angeles did have an appointment. After another call to confirm her insurer would reimburse her, she booked it.

Days later, she got a text from CVS: Her appointment had been canceled.

More than a week after new Covid vaccines were approved and recommended for all Americans aged 6 months and older, some are having trouble getting the shots. Insurance companies are denying coverage, with some blaming the difficulties on billing codes. Pharmacies are canceling some appointments because the drugs haven’t arrived. And because the government is no longer paying for everyone’s vaccine, headaches around in- and out-of-network coverage are adding to the confusion.

This is the first commercial Covid vaccine rollout since the start of the pandemic, marking the beginning of a newly privatized era for the drugs. Millions of doses have been shipped as hospitalizations rise. But, as with the earlier Covid vaccines, actually getting shots in arms has proved tricky.

“We’ve heard these stories, and we’ve contacted the insurers,” said Xavier Becerra, the U.S. health and human services secretary, at a press event on Wednesday, where he received his own updated vaccine. He stressed that anyone with Medicaid, Medicare or private insurance should have the shot covered without a co-payment, and that anyone without insurance could request a free shot at pharmacies participating in the Bridge Access Program. “We’ve contacted the pharmacists, and we’re working with them to make sure everyone understands how this works,” Mr. Becerra said.

Coverage is delayed for some people because the billing codes for the updated vaccines were not uploaded “in a timely manner,” said Danielle De Souza, a representative for the New York State Department of Health.

Insurance companies are working to fix the billing issues, said James Swann, a representative for A.H.I.P., a national association of health insurance companies. Anthem Blue Cross Blue Shield said Thursday that its payment systems were now updated. A representative for Cigna Healthcare said that “most” claims were correctly processing.

Several of the nation’s largest pharmacy chains acknowledged a challenging rollout. CVS, Walgreens and Safeway pharmacies have had to cancel and reschedule some appointments because of delayed shipments of the vaccines, the companies said. Other providers delayed making the shots available. Rite Aid said new vaccines would be in stores by this weekend; Kaiser Permanente said it would largely not administer Covid shots until next week.

Kit Longley, a representative for Pfizer, said in an email that the company was not experiencing any shortages of its vaccine and had delivered several million doses. Moderna released a statement on Thursday saying it had also shipped millions of updated vaccines and was working to support distributors to ensure the doses got delivered.

“We’ve gone from the federal government steering and driving vaccine supply and coverage to it being pushed out through regular market channels like it’s just another health care product,” said Lindsay Allen, a health economist at Northwestern Medicine.

Cynthia Cox, a vice president at KFF, the health policy nonprofit formerly known as the Kaiser Family Foundation, expressed frustration that some insurers had failed to update their systems in time, even though the billing codes were released over a month ago. “This is a somewhat unprecedented situation,” she said. “I think there’s some understanding that there could be hiccups. But at the same time, we’re three years into this, and insurers and pharmacies have had months to prepare.”

KFF did not know how many people were affected, she said. “At this point, we only have anecdotes, but we’re hearing so many of them that it feels like there is a widespread issue.” She added that health plans were supposed to cover vaccines at out-of-network pharmacies if there were no providers available in network. But Ms. Cox said that she herself could not get the vaccine at her local Walgreens in Silver Spring, Md., because the pharmacy was out of her network and wouldn’t accept a cash payment.

“Even though this is the exact area that I work in, there’s nothing I could do about it,” she said.

What to do if your coverage gets denied

“Our message is simple,” a representative for the Department of Health and Human Services said. “If you are being turned away for no coverage, please call your insurance for details about in-network coverage to receive the updated COVID-19 vaccine.” A representative from CVS advised people to schedule a later vaccine appointment if they ran into issues with their insurance.

Ms. De Souza, the representative for the New York State Department of Health, said that people who paid out of pocket should contact their insurers as soon as possible.