This article was written by City Cast Pittsburgh podcast host Megan Harris.
A couple of weeks ago on the City Cast Pittsburgh podcast, we talked about how the new COVID booster got approved, when it was coming to Pittsburgh, and that now was the time to get boosted. But it turns out, maybe that was a little premature.
All over Western Pennsylvania, folks have been posting about insurance denials and canceled appointments — often because pharmacies and doctor’s offices are telling people they’ll have to pay out of pocket. We’ve seen folks online post about prices up to $200 for a single shot.
Why Is It So Hard To Get?
Booster rollout has been troublesome nationwide. In the past, the federal government bought vaccines and distributed them for free; this year, pharmacies have to buy the vaccine directly from suppliers. As one health and policy expert told NPR, this is the first year the vaccine is being commercialized.
Another problem? Lack of supply. Pharmacies are scheduling appointments, but then don’t have the vaccine in stock. And this is the first time that insurers were supposed to cover the cost of vaccines as preventative medicine (instead of the government), but many haven’t updated their billing codes.
This last part is especially frustrating because we knew this was coming — the administrator with the Centers for Medicare and Medicaid services sent a letter to insurers back in July urging them to update their systems by mid- to late-September.
What Can You Do?
Confirm Your Coverage
Call your insurance company and confirm both that they’re going to cover the booster, and that they’ll honor that payment wherever you’ve made your appointment. You can’t go anywhere. The pharmacy or clinic has to be in-network, unless there’s nowhere to go in-network with the vaccine in stock. If that’s the case, insurers are supposed to cover it even if it's out-of-network – but you may have to fight.
Call the pharmacy or clinic the day of your appointment to confirm that they have the vaccine in stock. Many try to send automated cancellation messages if they run out, but those systems aren’t foolproof.
Experts say pharmacies should be getting more vaccines in stock in the coming weeks and insurance companies are supposed to be updating their billing codes.
You can request up to four free covid tests for your household at covid.gov/tests.