Insurance Companies Make It Difficult For Pediatricians

The human papilloma virus (HPV) vaccine (Gardasil, Cervarix) has been approved for use in girls for several years now, allowing us to protect our young female patients from many cases of cervical cancer and genital warts. While the benefits likely will not be seen for some time, as pediatricians we are excited to be able to provide, for the first time, definitive protection against a virus-caused type of cancer.

Approval for use of the vaccine against HPV in boys has been slower in coming, however. While they do not get cervical cancer, for obvious reasons, males are susceptible to other forms of disease caused by HPV, including genital warts, and they can also serve as a vector for transmission of this virus to their sexual partners, so including them in the target group for protection makes good scientific sense.

Recently, however, the American Academy of Pediatrics came out with a recommendation to use the vaccine (Gardasil) in males as well as females. This was followed by a similar recommendation by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). Having received this “official” approval, many of us have begun immunizing our adolescent male patients, and the acceptance of the vaccine by these patients and their parents has been encouraging. Initially, payment for the vaccine was an issue, but the vaccine has been approved for use by the Vaccines for Children (VFC) program, and most health insurance carriers are covering the vaccine for their insureds as well.

Most, but not all, however.

Our group, along with a number of others, has been told by the large national insurance company United HealthCare that the HPV vaccine is NOT a covered benefit for adolescent males. While other national insurance companies have been paying for the vaccine for months now, UHC was first waiting for the CDC to recommend it. Now that that has occurred, they state that they are waiting for that recommendation to be published in MMWR, the weekly report of the CDC, which can take time to occur, And after that, they claim that, by their contracts, they have an ADDITIONAL 60 days to begin to pay for it.

So despite the fact that this vaccine has been recommended and recognized as important for good health by many organizations and governmental bodies, United HealthCare is using SEMANTICS to delay covering a medical procedure which has been shown to be effective in preventing disease in patients who are paying premiums to United for just that sort of health assurance.

Frankly, in my opinion, this is a disgrace. The only reason for refusing to cover this vaccine upon CDC recommendation can be that United HealthCare does not want to cover the expense of this admittedly costly vaccine.

As physicians, we recommend that all adolescents, male and female, be vaccinated against HPV. And as parents, we want to do all that we can to protect our children, of both genders, from a preventable disease. If United HealthCare is your insurer, call them and object to their short-sighted and greedy policy. There is no reason that your children should be denied the protection paid for by virtually every other major health insurance company.

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