Group insurers must cover COVID vaccines without question until 4/21/21 (as of the time of this writing). They must cover vaccinations at no cost to you (if insured via a group health plan), even when the procedure is done by an out-of-network provider. Best practices would be still get any treatment done at an in-network provider to avoid any problems (avoid potential fights with the insurance company when possible).
Don’t be alarmed if you must still pay at the time of treatment. You may have to complete a reimbursement form to get the vaccine paid for. Think of it like cancelling services from Comcast (or telecom monopoly of your choice)… the process is arcane and time consuming by design to introduce a hurdle. These hurdles increase revenues / profits and it’s a business decision. Yes, it sucks, but that’s the operating procedure for many companies, including some insurance companies. The insurance company may require you to pay out of pocket, then complete a paper form, mail it in with the receipt, and then wait for a check to arrive via snail mail.
Insurance must also cover COVID tests, “when ordered” and must cover the test even when done at an out-of-network facility (until 4/21/21 as of the time of this writing). This hurdle requires you to get a referral for a test from a doctor. The best way to try to do this is via a phone call with your primary care doctor or via telemedicine (if your insurance plan offers that), then get the test. The same procedure for reimbursement may apply as described above. NOTE: Insurers are not allowed to require “prior authorization” by mandate from HHS, however, many insurance companies are interpreting “when ordered” as requiring a referral. How a “referral” is different than “prior authorization” is a legal issue that can be used to deny your claim… or at least a weapon to make you fight to get reimbursed if you didn’t get a referral.
I’ve said it for a while, Paperwork = Systemic Racism / Classism. People who can afford to hire lawyers and accountants to do their paperwork, are better off than people who cannot. I’ve seen Presidential administrations come and go claiming to be populist and “for the people”… let’s see if this administration can generate any ideas that don’t involve more paperwork, or at least paperwork without difficult built-in hurdles, or maybe government spending on infrastructure to create jobs.
Here’s to 2021, I think it’ll be a good one. Please get your vaccine so we can all play again.