The Gist: Insurance coverage denials for the updated coronavirus vaccines are prompting increased scrutiny from the U.S. Department of Health and Human Services. The situation has become so dire that Secretary of the U.S. health department Xavier Becerra sent a letter reminding insurance companies of their legal obligations.
What Happened?: For some seeking the updated COVID-19 vaccines, running into an insurance roadblock is turning what should be a straightforward process into a bureaucratic headache. Amid these struggles, the Secretary of the Health and Human Services penned a letter directed at insurance companies. The letter emphasized the immediate necessity of covering these updated vaccines without imposing any cost-sharing requirements on plan members.
By The Numbers:
- The Food and Drug Administration authorized the updated COVID-19 vaccines from Pfizer and Moderna on September 11.
- According to the Centers for Disease Control and Prevention, 40 hospitalizations are prevented for every 10,000 vaccinations given to those 65 and older. That is only 0.4%.
- Health care payers were first reminded of coverage requirements by the Centers for Medicare & Medicaid Services on July 13 and again on September 20.
Why It Matters: Insurance hiccups are more than just an inconvenience— according to the secretary’s letter, they can be a matter of life and death. In the letter, Becerra says with every day of claim rejections, the opportunity to prevent hospitalizations, and more critically, save lives, slips further away.
The health department is urging health care payers to act swiftly in rectifying these issues and ensuring coverage for the vaccines.
What’s Next?: The Secretary’s letter strongly advises insurance companies to work on navigating the insurance network better, particularly clarifying the differences between medical and pharmacy network options. Meanwhile, consumers are encouraged to contact their health insurance providers directly for more information on obtaining their COVID-19 vaccines without cost-sharing.
Local Angle: For Georgians, this development could affect how smoothly updated vaccines are distributed across the state. People are advised to check with their local providers and insurance plans to ensure they’re covered for the vaccine, without any unpleasant surprises.
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