Print this page or "cut and paste" the body of the letter.  Some addresses for some of the medical insurance companies are also provide below the letter.


Dear Sirs:

We are writing this letter to make you aware of a situation plaguing all pediatricians. The reimbursement fees for many of the vaccines for your company are too close to the cost of the vaccines. As soon as there is a small price increase to the pediatrician, the reimbursement is no longer enough to cover this cost.

There are several issues worth considering:

The codes for administrative services, (CPT codes 90471, 90472, 90473, 90474, and additional codes for different vaccine types in the future), are NOT part of the vaccine reimbursement, and should not be considered when determining what is paid. These are separate services, given a unique value by CMS (the regional based relative value scale) to account for the procedure of giving a vaccine. This service includes:

The State Department of Health has determined that an appropriate fee for the administration alone is $17.65 per vaccine! They provide the product (the vaccine and cost of the federal excise tax) in addition to the administration fee. It is reasonable, then, that the total reimbursement for the administration of any vaccine should be $17.65 over the cost (vaccine plus excise tax), and that if an HMO does not honor an administration code, that the vaccine itself should be reimbursed at least $17.65 above its cost!

There needs to be a mechanism in place to adjust the payment for vaccines as soon as the prices change. Also, there should be a reasonable overhead adjustment of at least 20% above the AWP to account for the above-mentioned issues.

We cannot continue to provide vaccines to patients enrolled in your plan at a financial loss. Please review the compensation made to pediatricians for immunizations as soon as possible, keeping in mind the points made above so that we do not have to address this issue again in the near future, and inform us what your reimbursement to us will be.

Respectfully yours,



Medical Directors

980 Jolly Road
P.O. Box 1109
Blue Bell, PA 19422-0770


3541 Winchester Road
Allentown, PA 18195-0501

Empire Blue Cross/BlueShield
11 West 42 Street
New York, NY 10036
Attn: Alan Sokolow, MD

Choice Care/Humana
1100 Employers Blvd.
Green Bay, Wisconsin, 54344

499 Washington Blvd.
Jersey City, NJ 07310
Attn: Kurt Weimer, Pres. NY,NJ

Empire Plan US Gov't United HealthCare
P.O. Box 1600
Kingston, NY 12402
Attn: Dr. James Manion

PO Box 2857
New York, NY 10116
Attn: Dr. Aron Ron


Dr. Michael Staser
441 9th Avenue
New York, NY 10001

Great-West Healthcare
475 Park Avenue South
23rd Floor
New York, NY 10016
Attn: Joan Russo, Network Management

25 Broadway
New York, NY 10004

7 West 34th Street
New York, NY 10001
Attn: Dr. Edward Anslem

HORIZON Health Plan
P.O. Box 79
Newark, NJ 07101-0079

330 West 42nd Street
New York, NY 10018

One Huntington Quadrangle
Melville, NY 11747
Attn: Dr. Ron Perrone

P.O. Box 5032
Norwalk, CT 06856-5032

399 Knollwood Road
White Plains, NY 10603
Attn: Dr. Scott Breidbart

United HealthCare
2 Penn Plaza
New York, NY, 10121
Attn: Dr. David Falk

Attn: Dr. Lisa Bancke

Attn: Dr. Steve Rosenberg

VYTRA Healthcare
395 North Service Road
Melville, NY 11747
Attn: Lonnie Divack, MD