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Are doctors paid per vaccine administered?  

post #1 of 9
Thread Starter 
Hi,

I am wondering how vaccines and $ work. Does a doctor pay for a shipment of vaccines and then hope to sell them to patients? And if they are not sold by the expiration date, then the profit is lost?
post #2 of 9
Quote:
Originally Posted by aiea View Post
Hi,

I am wondering how vaccines and $ work. Does a doctor pay for a shipment of vaccines and then hope to sell them to patients? And if they are not sold by the expiration date, then the profit is lost?
Our doctor orders them over from the pharmacy when they are required, in the amount that is expected to be required. That is why some peds want your schedule written down if you're vaxxing on a delayed schedule--they need to know what to bring in for your child's scheduled appt at $month. (And we've actually run into problems with this--my husband wanted Hep A and B due to the areas of the world he travels to, they don't keep them in the office and have to order them in so he could start the series . . . and they forgot.)

I'm sure there are other doctors that operate differently though.

From what I've seen on our EOBs, our doctor gets paid (by insurance) about $60 for a well-child appointment, plus about $25 per standard childhood vaccine. I'd have to double-check to see if there have been any higher reimbursements than that, but I really don't recall having seen any. But we haven't opted into any of the "new, recommended but not required" ones and those are the ones that tend to cost more.

(Oh, and that $25 is the high I recall seeing. I read through all our EOBs when they arrive, and something--I don't recall which one--was reimbursed at $8, a few at about $10-15.)
post #3 of 9
There was short period of time when we didn't have insurance (DH had started a new job and benefits hadn't kicked in yet)- so we paid OOP for ds's vaccinations at each ped. appt. They were $14.50. It was billed in addition to the well-child visit ($80, if I recall).
post #4 of 9
Thread Starter 
The replies are much appreciated! And I did not realize how inexpensive vaxes were... $14.50 total cost, $25 total cost? For some reason I had the notion they were between $50 and $100 USD apiece.
post #5 of 9
Quote:
Originally Posted by aiea View Post
The replies are much appreciated! And I did not realize how inexpensive vaxes were... $14.50 total cost, $25 total cost? For some reason I had the notion they were between $50 and $100 USD apiece.
Many of the "basic" childhood vaccines have long ago entered the generic marketplace. And doctor's offices are "competing" with local health departments, who often offer the generic versions at no or very low cost.
post #6 of 9
Oh, but note that my numbers are what the doctor gets paid BY insurance reimbursement (and preventative care/vaccines are covered 100% by our insurance so we don't pay any "extra"). What they submit TO insurance is usually in the $40-50 range per vaccine.

Supposedly, if you went in off the street without insurance, what you'd get charged would be what they submit TO insurance. But nowadays, some practices have "cash" prices that are closer to the reimbursement offered by your standard insurance policy. And some doctors who don't have those cash prices or who have patients whose vaccines are excluded by insurance will tell parents to go to the no/low cost vaccination clinics.
post #7 of 9
Vaccines are provided free courtesy of the state where I live. Doctor's just charge for administering the vaccine (ie., $80 office visit or $20 co-pay). They health dept provides them at not administrative charge.
post #8 of 9
The bill for my DD's 2 mo WBV was $550! That wasn't what insurance paid, I'm sure, but I was just mad as H3LL that they were charging that much for something I felt hoodwinked into getting in the first place! They were lucky insurance covered it, because I would have fought tooth and nail not to!
post #9 of 9
At a recent ACIP meeting they were discussing combo shots...

http://209.85.165.104/search?q=cache...lnk&cd=1&gl=us

Quote:
Dr. Chilton commented that currently the administration fee given to practitioners is dependent on the number of shots, not the number of antigens, so many pediatricians must decide whether to spare pain or to earn more money.
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Mothering › Forums › Health › Vaccinations › Are doctors paid per vaccine administered?