Start of school just got pricier

By Marshall Allen

Friday, July 18, 2008 | 2 a.m.

Parents of incoming kindergarten students may have to pay for chickenpox vaccines that were previously offered for free, because Nevada has stopped picking up the tab for children who are covered by health insurance.

Health officials say the cost to some parents could be as much as $111. Some insurance companies say they will pick up at least part of the tab, if not all of it. The level of coverage is being examined in some cases because the state’s cutback came as a shock.

Uninsured children will still receive free immunizations, which are mandated for kindergarten students in the Clark County School District.

The change in payment for the vaccination has surprised parents whose children in previous years have received the free shots and who expected the same medical freebie this year.

“It comes as quite a shock to them,” Henderson pediatrician Dr. James McGhee said of the parents. “It’s going to be difficult for everyone to get their children vaccinated.”

The cutback will exacerbate the deplorable record for immunizations in Clark County, which the Centers for Disease Control and Prevention ranks as the nation’s worst urban area for overall vaccination coverage. Nevada ranks sixth-worst in terms of the number of children who have been vaccinated against chickenpox.

The state will continue funding the vaccinations for chickenpox, also known as varicella, for children who qualify for the CDC’s Vaccinations for Children program — those who are uninsured, have insurance that does not cover vaccinations, American Indians and those eligible for Medicaid, the government’s insurance for the poor. Children covered by Nevada Check Up, which covers the poor and uninsured, will also be covered.

But on July 1 Nevada joined about 40 other states that don’t provide the chickenpox vaccine for insured children. About 30,000 insured children in Clark County, and another 9,000 elsewhere in Nevada, received state-funded varicella shots during the 2007-08 fiscal year.

In theory, insurance companies would pick up the bill for the shots. But the change is new to them, too, so the situation is in flux.

Officials from Anthem Blue Cross and Blue Shield, which covers 360,000 Nevadans, the majority in Clark County, said they will reimburse doctors up to $83 for the shot, which would cover the estimated cost. But in other cases doctors say health plans refuse to pick up the entire tab for vaccinations, and they don’t want to get stuck with the bill. Officials of UnitedHealthcare, which recently took over Sierra Health Services, were not available for comment.

State officials say ending the free shots for insured children was necessary because the annual $34 million vaccination budget has been stretched thin in the past decade as the number of immunizations for children has tripled to about 18. The breaking point was three months ago, when they learned of a $578,000 reduction in federal funding.

Doug Banghart, immunization program manager for the Nevada State Health Division, said the decision jeopardizes efforts to increase the number of children being vaccinated.

News of the cut in federal funding reached state officials about three months ago. They told providers July 3, but the state has not yet announced the news to parents. Incoming kindergarten students must be immunized by Aug. 25, the first day of school.

Nevada has leaned on doctors to come to the rescue. Health providers learned of the change via a fax in which officials from the state health division said they “strongly encourage you to privately purchase this vaccine for your insured patients.”

But pediatricians won’t buy the shots, which cost about $77 for the dose alone, until they know they’ll be fully reimbursed for them, said Dr. Lisa Glasser, a member of the American Academy of Pediatricians.

It’s doubtful that every insurance company will cover the entire cost, Glasser said. For example, some insurance companies reimburse patients only $61 for the Prevnar vaccine, which costs $80, she said. If some insurers treated the chickenpox vaccine in the same manner, a doctor’s losses would quickly add up, Glasser said.

“I’m not going to subsidize the health insurance plans,” Glasser said. “There is just no way that doctors are going to take that kind of risk.”

Insured parents shouldn’t expect any mercy from the schools, which view the shots as a public health necessity. Diana Taylor, director of student health services for the School District, said schools won’t compromise their immunization mandate. Children will not be allowed in class without the vaccinations, she said.

“That’s going to be a problem for us,” Taylor said of parents who will not get their children vaccinated because of the cost.

Glasser and McGhee said they’re sending insured parents to the Southern Nevada Health District, where they pay $95 for the vaccine, plus a $16 administrative fee. The parents can then try to get reimbursed by the insurance companies, the doctors said.

Bobbette Bond, government and community affairs coordinator for the 120,000-member Culinary Health Fund, said the provider will cover at least some of the cost of the shots, though it has not been determined how much doctors will be reimbursed.

Bond said she is “seriously concerned” about the cutback and added the state should have a role in funding the varicella vaccine for insured patients.

“This state has the lowest immunization rates in the country,” Bond said. “You’d think if they’re worried about being last they’d do more to help instead of less to help.”