PacifiCare Out $280 for Discouraging Vaccine
PacifiCare Health Systems Inc.’s restitution for discouraging doctors last year from vaccinating babies for chickenpox amounts so far to a mere $280.
The Cypress-based health maintenance organization says it has received only seven valid claims from doctors seeking reimbursements for shots given either last year or during a makeup period this year that ended Monday. The state’s Department of Corporations, which regulates HMOs, last spring required PacifiCare to pay $40 a shot to immunize babies who missed out on the shots last year, or reimburse doctors who paid out of pocket to give the shots last year. State law specifies that HMOs follow guidelines of the American Academy of Pediatrics, which recommends the shots for babies ranging from 1 year to 18 months in age.
Ben Singer, a company spokesman, noted the company denied 204 claims because they didn’t meet terms of its agreement with the agency. Many claims lacked sufficient documentation by physicians or pertained to children outside of the age group, he said.
He also attributed the low level of claims to a lack of public interest in the matter. He said many parents probably decided in conversations with their children’s physicians last year whether or not to have their children vaccinated.
However, Jamie Court, director of the Santa Monica-based Consumers for Quality Care, attributed the low response to doctors’ unwillingness to risk jeopardizing their business relationship with a large HMO by filing a claim and being tagged a troublemaker.
Court also criticized the state for ordering a penalty that amounts to a “slap on the wrist” for a large corporation. He said the agency, instead, should have fined PacifiCare at least $100,000 for interfering in the relationship between patients and their doctors.
Warren Barnes, the agency’s supervising counsel, said the deadline for physicians to submit claims has been extended to Nov. 30. He did not elaborate.
Last year, PacifiCare discouraged physicians from providing the vaccinations, questioning whether the widely accepted preventive measure would prevent chickenpox from occurring throughout a person’s lifetime.
