Insurance delays have kept some Philadelphians from getting the latest COVID vaccines

Mark Danowsky found a “chaotic scene” at his local CVS when he arrived for his COVID vaccine last Friday. Pharmacists told him they couldn’t get his insurance to cover the cost of the newly approved shot, and that if he wanted it on the spot, he’d have to pay $190 out of pocket.

“I asked [pharmacy staff] when they thought they’d figure it out, and they were, like, ‘Give us a couple of weeks,’” said Danowsky, of Wayne.

Others in line were also experiencing similar problems — some had been there an hour already, they told him.

Pharmacies began booking appointments for the updated COVID vaccine soon after it was authorized by the Food and Drug Administration on Sept. 11. But insurers weren’t quite as fast, and some are still in the process of updating their billing codes to enable them to pay for the shots. The rollout of the updated vaccine, which is recommended for all Philadelphians aged six months and up, has also been hamstrung by shipping delays.

» READ MORE: Some Philadelphians showed up to get a new COVID vaccine, but couldn’t because of shipping delays

In a statement, Independence Blue Cross, the region’s largest insurer, said an “unexpected delay in coding” had resulted in some customers being told to pay out of pocket for the shots.

“This is something that is impacting most health insurers that are covering the vaccine,” a company representative wrote.

As of Tuesday, the company had resolved that issue, and customers shouldn’t see any delays in their coverage. People insured by IBX who paid out of pocket for the vaccine can request reimbursement.

IBX will cover COVID-19 vaccines and boosters for its members as long as they receive the shots from a provider in their health-care network. The company recommended that customers check their health plans to find out whether they can receive a shot at an out-of-network provider.

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Highmark, another major insurer with patients in Southeastern Pennsylvania, said it will cover COVID vaccines for members with preventive care benefits in their coverage plans. Members without preventive care benefits might have to pay out of pocket, said Anthony Matrisciano, a Highmark corporate communications representative.

Setting up coverage for the updated vaccine “may take a couple of weeks,” he said. Still, people with preventive care benefits who get the shot before that coverage is set up “won’t be responsible for paying any costs,” Matrisciano said.

Two other large insurers, Aetna and UnitedHealthcare, did not return a request for comment.

Medicare, Medicaid and CHIP all cover the updated COVID vaccine. The city health department said last week that people who are uninsured, or whose insurance does not cover the vaccine, can get it for free through a federal initiative called the Bridge Access Program.

CVS said it would reschedule appointments for customers whose insurers haven’t updated their systems to reflect the new billing codes for the vaccines.

Walgreens representatives said the company would not turn away anyone whose insurance doesn’t cover the vaccine, saying that government programs such as Bridge Access would fill the gap. The company said it is “committed to ensuring everyone who is eligible and wants a vaccine receives one.”

The prospect of rescheduling his appointment wasn’t much comfort to Danowsky. He signed up for an appointment as soon as he could because he has asthma and knows he is at risk of severe respiratory illness. He’s never had COVID.

This week, Danowsky went back to his local CVS in hopes the insurance issue had been resolved. By then, he said, pharmacists there had encountered another setback: They had already run out of shots.