HMSA members faced with delays, billing issues in seeking new COVID booster

HONOLULU (HawaiiNewsNow) – HMSA members seeking the new COVID booster this week were left confused and frustrated after billing issues prevented them from getting the shot for free.

The state’s largest health insurer Thursday afternoon it’s fixed the problem and is now covering the vaccines. But earlier, members say they were being turned away or asked to pay upfront, as much as $200.

HMSA blames the problems on delays in entering new billing codes into its system.

Maui resident Martin Zorn said as soon as the new COVID vaccine was available at the Long’s Drugs in Pukalani, he booked an appointment.

But he never got a shot.

“Long’s told me (HMSA is) not covering it. It’s not in the formulary,” Zorn said.

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“And I said, ‘as long as it’s scheduled, can I come in and pay it out of pocket and then submit it for reimbursement to HMSA?’ And they said, ‘you have to call HMSA.’”

He did that.

“The person I talked to had no idea, it’s like, ‘we’re working on it.’”

Zorn said the delay is frustrating.

“We all knew this was coming,” Zorn said. “What other issues do they have with their computer system? It’s not like it’s a surprise.”

But HMSA said it was surprised at how quickly the shots hit the market.

Prior vaccines were fast-tracked because the federal government foot the bill. This one requires new codes for the commercial market ― and HMSA says it’s a steep learning curve.

“It happened so much quicker than we thought, for better or for worse,” said Dr. Stefanie Park, HMSA vice president and chief medical officer.

“The vaccines were approved last week Monday, and then CMS, the federal government, released the rates on Thursday. It was a really quick turnaround for us to set all of these things and get them into our systems.”

Patients say the insurer dropped the ball.

Zorn says HMSA was still not covering shots at the Long’s near him on Thursday morning.

“My wife has some immune deficiency, and I wanted to get it because I don’t want to take the risk of bringing something home into the house either,” he said.

HMSA members who paid upfront for a COVID vaccine are advised to go back to the pharmacy and request a refund.

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