Many New Yorkers began hunting down the updated COVID-19 vaccine, tailored to this year’s dominant variant of the coronavirus, after the U.S. Food and Drug Administration and Centers for Disease Control and Prevention signed off on the shot last week.
But while some have had no trouble, other New Yorkers have faced last-minute appointment cancellations at chain pharmacies, either because supplies had not arrived yet — or because of insurance snafus.
Insurance coverage for the vaccine is not supposed to be an issue. The vaccine should be free for everyone, either through their health plan, or through the federal Bridge Access Program, which was launched last Thursday. The CDC recommended the updated shot for everyone over 6 months old, and most health plans are required to cover CDC-recommended vaccines under the Affordable Care Act. Anyone who is uninsured or has a copay can turn to the Bridge Access Program, which will run through the end of the year.
But Brooklynite Hannah Bae said she paid $190 for a Moderna shot at a CVS on Saturday. She said she received a call from the pharmacy in Downtown Brooklyn about 15 minutes before her 10:30 a.m. appointment notifying her it had been canceled because her insurance plan had yet to approve coverage for the vaccine. Bae said she was eager to get the shot one way or another and ended up putting it on a credit card.
“I haven’t had COVID as far as I know, and I feel quite vulnerable because I only have the protection of the previous vaccine doses,” Bae said. “Everyone I know in my life has COVID right now or has been exposed to COVID.”
It wasn’t until she “rage posted” about the experience online that Bae learned about the Bridge Access Program, which she said no one at CVS mentioned. And according to state health officials, CVS should have had no problem billing Bae’s insurance instead of charging her. They explained that the headaches come from delayed insurance updates and emphasized that no one should pay out of pocket.
City-run sites, meanwhile, are coming online after pharmacy chains because the this vaccine’s rollout is different from the rollouts of previous versions. Manufacturers Moderna and Pfizer-BioNTech are sending doses directly to pharmacies and health care providers, rather than distributing the supply through the federal government. Large pharmacy chains were among the first to receive the vaccine, but publicly run sites, nonprofits and some independent pharmacies are waiting to launch.
Insurance issues sow confusion
Bae is enrolled in New York’s Essential Plan, a publicly funded insurance program for low-income people that is overseen by the state’s health department. She enrolled in her particular plan through Empire Blue Cross Blue Shield. All Medicaid and Essential Plan policies began covering the updated COVID vaccine on Sept. 11, according to health department spokesperson Danielle DeSouza.
However, DeSouza said the health department is aware of some delays in coverage for the new vaccine because privately run medical databases did not update their billing codes in a timely manner for insurers and pharmacies. It’s an issue that has reportedly affected the rollout nationwide.
DeSouza added that for those on the Essential Plan, “plans will reimburse consumers if they were inappropriately charged.” But it’s unclear whether the insurers administering the policies will honor that promise.
Stephanie DuBois, a spokesperson for Anthem, which runs Empire, said any member who was not able to get a free shot last week “can return to receive it at $0 copay.” She did not respond when asked if the insurer would reimburse a member who already paid out of pocket.
Jennifer Bristol, a Medicaid member, had a problem similar to Bae. According to DeSouza of the state health department, the Medicaid codes for the updated COVID vaccine were activated last Friday, Sept. 15, and the state distributed guidelines on billing to health care providers on the same day.
Yet, Bristol said she was turned away from a CVS in the Bronx because of insurance issues three days later. She tried to make another appointment for this coming Monday and it was canceled again. She said she reached out to her insurer, MetroPlusHealth, which is run by NYC Health + Hospitals. She has found them to be “helpful and responsive,” but the issue has yet to be resolved.
“We are investigating this issue and will provide clarity on member concerns about potential vaccine denials as soon as possible,” MetroPlus spokesperson Michelle Dominguez said on Wednesday.
CVS, meanwhile, has pointed a finger at insurers.
“Some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines,” spokesperson Matt Blanchette said in a statement. “If this happens, our pharmacy teams can help patients schedule an appointment for a later date.”
Blanchette added that all CVS locations are participating in the Bridge Access Program. “If it’s determined a patient is uninsured, they are eligible for an updated COVID-19 vaccine through the CDC’s Bridge Access Program at no cost,” he said.
How to find the vaccine – and avoid canceled appointments
Health clinics run by the city and nonprofits are starting to gain access, and more will get the vaccine in the coming days, said Patrick Gallahue, a spokesperson for the city health department. Facilities run by NYC Health + Hospitals will have vaccine appointments available starting Oct. 2, said spokesperson Christopher Miller, who added that patients can start booking appointments now.
Vito Colombo, the owner of Colombo’s Pharmacy in Queens, said independent pharmacies have also had to wait for their doses. He said he pre-ordered the vaccine from Moderna about two weeks ago, but the order is still pending. Meanwhile, he’s receiving frequent calls from customers asking about the vaccine and when it will be available. He advises them to just keep checking back.
Locations that have the vaccine are supposed to be listed on vaccines.gov and the NYC Vaccine Finder site, where users can search by ZIP code. But not all of the providers listed on those sites actually have doses in stock, and some providers offering the vaccine aren’t yet listed. The city health department tweeted this week that New Yorkers should call ahead to their pharmacy or doctor to find out if the vaccine is available instead of relying on search engines.
Gothamist has heard from about half a dozen New Yorkers who said they had one or more appointments canceled by CVS or Walgreens in recent days because of a lack of supply.
Irina Manta said she initially booked vaccine appointments for her and her family at a conveniently located CVS in Manhattan on Monday, only to have them all canceled because the pharmacy was out of stock. Eventually, she and her family members ended up getting doses at pharmacies scattered throughout the city. For Manta herself, it took four tries. At one Walgreens, she said she wasn’t informed about the shortage until she arrived.
“I am obviously a highly motivated person when it comes to this stuff,” Manta said. “But I can imagine there being people out there who get really disheartened by the experience and end up just giving up.”
Walgreens spokesperson Julia Loring said, “We are aware of isolated incidences at a small number of locations where appointments had to be rescheduled due to delays in supply” and encouraged patients to call ahead “for the best experience.”
CVS spokesperson Blanchette said stores are receiving supply on a rolling basis and “the majority of our locations are able to honor scheduled appointments.” But he said, “due to delivery delays to select stores, some appointments may be rescheduled.”