A bill proposed by the California Academy of Family Physicians, if approved, would make it illegal for health plans to reimburse physicians for childhood or adolescent vaccinations in amounts less than the physician's actual cost of acquiring and administering the vaccine. Without the legislation (AB2093), physicians like Marsha McKay, DO, a solo practitioner in Twain Harte, Calif., will be forced to continue sending patients to the health department or nearby health clinics to get vaccinated against pertussis, of which the state has confirmed 910 cases and five infant deaths this year, reports HealthLeaders Media.
Although the whooping cough epidemic is at the center of the discussion, inadequate vaccine reimbursement is not a new problem. According to a December 2008 Journal of Pediatrics study, as many as 10 percent of doctors who provided vaccinations to privately insured children were considering dropping the practice because of its expense.
Tom Reilly, CAFP spokesman, said that even if an insurance company covers the cost of the vaccine, it won't pay for storing and administering the vaccine. One round of pertussis vaccines for a child costs a doctor's office about $450.00.
Doctors are, however, given a reimbursement fee for uninsured children, who receive the vaccines free of charge through the federal Vaccines for Children program or Medi-Cal. The California Department of Public Health also provides free doses of the vaccines to county and hospital systems, notes an article on Examiner.com.
Nonetheless, Sumana Reddy, MD, who runs a rural family practice in Salinas, told the Mercury News that she sometimes has trouble meeting payroll because there are up to $40,000 in outstanding charges for vaccines to insurers. "Even doctors who work hard to purchase the vaccine at the best available rate often cannot match the low reimbursement that insurance pays for that vaccine," Reddy said.
When McKay complained to Blue Cross, the insurer told her to attach the invoice of what she paid for the vaccine to each claim and it "would consider" paying enough to cover her costs. She has also asked patients to pay cash up front, and then get reimbursed from their insurance companies. But, she told HLM, "No one has taken me up on that yet. They can hardly afford their premiums and their co-pays."
The bill, which is to be heard by the Senate Health Committee next week, is opposed by the California Association of Health Plans, which says it overarches on the type of costs that should be covered, reports the Mercury News.
To learn more:
- see the article on Examiner.com
- check out the story from HealthLeaders Media
- read the article in the Mercury News