The $800 immunizations, part 1

Why does a set of immunizations cost $800 (and cost me, the consumer and new parent, $650 out of pocket)?

I got a letter from my insurance company a few days ago saying that it is my responsibility to pay around $800 -- no wait, we negotiated it down for you, to $650 -- for my son's four-month checkup and set of routine immunizations.

Before the four-month well-child (or "well-baby") visit, I had read The Vaccine Book, and I knew the risks and benefits of each vaccine my son was going to receive. Still, I decided that the benefits outweighed the risks for us, and we got all of the immunizations that were recommended by the American Association of Pediatrics (AAP).

So, at the well-child visit, we got the following vaccines (combined into three shots and an oral), as recommended by the AAP. These are the same vaccines as we got at our two-month well-child visit.

• Second DTaP (diptheria, tetanus, pertussis) vaccine
• Second polio vaccine
• Second Hib (Haemophilus influenzae type b) vaccine
• Second hepatitis B vaccine (since the first was done at one month, not birth)
• Second rotavirus vaccine

The letter that I received from the insurance company lists the following. I have broken it down by vaccine and administration fee as listed on our doctor's bill from our two-month well-child visit.

Preventitive Service

• Total billed: $161.00.
• Amount exceeding the benefit maximum: $64.00
• In excess of the allowed expense: $48.90
• Claims payment: $31.28

Immunization: DTaP/Hib/Ipv (polio) Vaccine (Pentacel)

• Total billed: $84.00
• Amount exceeding the benefit maximum: $84.00

Immunization: administration of the first vaccine (injection)

• Total billed: $65.00
• Amount exceeding the benefit maximum: $65.00

Immunization: Pneumococcal Conjugate Vaccine

• Total billed: $211.00
• Amount exceeding the benefit maximum: $211.00

Immunization: administration of 2+ vaccines (injection)

• Total billed: $42.00
• Amount exceeding the benefit maximum: $42.00

Immunization: Rotavirus vaccine (Pentavalent)

• Total billed: $104.00
• Amount exceeding the benefit maximum: $104.00

Immunization: administration of 2+ vaccines (oral)

• Total billed: $38.00
• Amount exceeding the benefit maximum: $38.00

Immunization: Hep B vaccine

• Total billed: $85.00
• Amount exceeding the benefit maximum: $85.00

Immunization: administration of 2+ vaccines (injection)

• Total billed: $42.00
• Amount exceeding the benefit maximum: $42.00

It is your responsibility to pay: $654.42

It is not your responsibility to pay: $147.30 (How kind of them to allow us "patient savings!")

I thought this was kind of ridiculous. Especially since these are not frivolous expenses -- these are immunizations that all infants should get. I called the insurance company to see if there was some mistake. The result? No, it's no mistake: the benefit maximum per year for immunizations is $750. Dollars. Per year. It is worth noting that my quarterly premium is around $700 for my son.

In the first year, infant immunizations are part of the well-child checkups at one month, two months, four months, six months, nine months, and 12 months. Check out the government article on well-child visits.

This means that the first and second round of shots -- at one month and two months, respectively -- cost around $750, were covered by insurance, but consumed my entire allowable for vaccinations for the year. The next round -- at four months, about which I am writing -- cost around $800, but were negotiated down to around $650, and will in all likelihood have to be paid out of pocket. The six-month round of vaccinations, which we just got two days ago, will be another $650 out of pocket. And... there is still one more visit to go before the end of the benefit year, on September 20.

The really depressing thing is that this is the insurance provided to graduate students here at the university. And I have to pay -- through the nose, as where is a grad student going to come up with $700 each quarter? -- for my son's premium.

Be warned, moms of new babies. I do not want to sound like Michael Moore, but it feels like I should be choosing the immunizations that are the least expensive, not the ones that are most important.

Congratulations, Anthem Blue Cross. You have transformed thinking about vaccinations from a risk-benefits analysis to a cost-benefit analysis.