Patients lose when insurers cut reimbursement for immunizations

I recently received a declaration of war from one of the major healthcare insurers.  Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%.  I do not have a 40% margin on immunizations and injectable medications.  My margin is at most 10%.  This means that with a 40% reduction, I will have to pay at least 30% of the cost of your immunization and injectable medications.

Yes, you read that correctly.  I will have to pay for your shots.   Every time I give a child an immunization that costs me $50 dollars, I will pay $15.  This is not a joke!  Giving a typical series of four vaccines could result in a loss of $100 on the vaccines and a net loss on the entire well care visit.  No doc can afford to pay to see patients!

Your doc and I have three choices.

  1. We can stay in plan and lose more money than we make.
  2. We can simply treat patients unfortunate enough to have this insurance as second class citizens, sending them to the county health department for immunizations and to the ER for intramuscular antibiotics/pain medications.
  3. We can abandon this contract altogether.  This means that we either stop seeing patients with this insurance or continue to see them only if they can afford to pay cash.

There are no good options.  Losing more money than you make is unsustainable.  Treating anyone as a second class citizen is wrong.  Losing some of my most favorite patients will be painful.

With those options on the table, physicians must decide that it is time to get back to work treating patients as individuals and not according to the edicts of their insurance companies.  It is time to stop being a PCP and return to my roots as a family doc, free to keep my patient’s information confidential, free to advise my patients as I see fit, free to prescribe what is necessary regardless of formulary constraints, and free to provide the best care anywhere in the world.  Yes, patients will have to pay for what they get.  Freedom has a price!  Yes, I will lose patients.  That will be my cost of freedom.

Insurance contracts that doctors sign have a gag clause in them.  I am gagging on that clause at this very minute.  I have written a letter of protest to this Goliath of the corporate world, stating my patients’ and my own case.  Should they fail to relent in their efforts to further engorge their pockets with our (yours and mine) cash, I will withdraw from this contract and notify those patients affected by this new (insane) policy that I have done so.  I suggest that all of you contact your insurance companies and ask whether they have instituted this kind of ridiculous policy.  If they have and if you want to continue seeing your current doctor, lodge your complaint – make your voice heard.  Maybe together we can avoid this catastrophe.

Stewart Segal is a family physician who blogs at

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