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Vaccine Showdowns (Go EBP!)

My apologies to the readers of the SOAPM mailing list, as this is a repeat, but there are too many folks who would otherwise miss this piece from the San Francisco Chronicle:

Doctor-insurer disputes force parents to pay up front for shots

It's the children who feel the sting of vaccinations, but it's their
parents who can get stuck with a sharp bill for shots they thought their
health insurance would cover.

Some pediatricians, faced with a growing number of recommended
immunizations and rising prices, are starting to restrict or refuse to
administer some vaccines unless patients pay in advance - and the prices
can add up to hundreds of dollars.

East Bay Pediatrics Medical Group, for example, which has nine full-time
physicians and offices in Berkeley and Orinda, informed its 1,800 Blue
Shield of California patients that, as of Aug. 1, physicians would not
administer four specific immunizations without payment up front....

"This is a business dispute, but the parents and kids are being squeezed
in the middle of this," said Dr. Myles Abbott, a pediatrician with the

The piece goes on in some detail (and, whatever you do, don't read the comments from readers), but Dr. Oken was able to provide additional insight on the SOAPM list:

Two items that were incorrectly mentioned in the article : 1. They are not offering to pay 100 % AWP (in fact they want to reimburse Prevnar at below our acquisition cost). 2. They are not the "highest reimbursing health plan in California."

I agree with the practice that it is sad that it has to come to this. But, ultimately, we (the consumers of health insurance) need to play our parts. It's going to get worse before it gets better - we're going to see more of these fights, no question.

Tags: Insurance, pediatric, pediatrician, rvu, Uncategorized, aap

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