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MANAGED CARE: Q & A How can pediatricians assure they are properly reimbursed for immunizations under managed care contracts?

Managed care has been thrust upon the pediatric community. In many areas and with several managed care plans, the welfare of children has been challenged, as sometimes evidenced by the haphazard approach these plans have toward immunizations. This contrasts with pediatricians' view of immunizations as the major breakthrough in health care over the past 40 years.

In pediatrics, immunizations amount to the largest part of expendable over-head. With refrigerator stock of vaccines worth thousands of dollars, pediatricians must closely monitor what they pay for vaccines vs. the amount reimbursed. Many managed care plans include the cost of immunizations in their cap rate. Other plans designate immunizations as "carve outs" from the cap — reimbursed according to a fee schedule — while others offer them at reduced fee for service.