Last week in comments on a diary unrelated to this topic, DKos sherlyle wrote that her daughter in Illinois had been told by her insurer that immunizations for her children were considered "elective" and therefore the insurance company would no longer pay for them. It cited waivers in the Illinois state laws that allow parents to opt out of immunizations usually required for school entrance and attendance. http://www.dailykos.com/...
My daughter's insurance company no longer pays for regular child immunizations - says they're "elective", not required by schools anymore, since you can sign a waiver. Is that true for where you are, too? Sounds to me like a medical disaster waiting to happen. (this is in IL)
I happen to work in the area of children's health care, with emphasis on children's coverage and immunization, so I was pretty shocked by this. I went on the Illinois state site to see if there was a new law, making immunizations for schoolchildren voluntary, that might explain this action by the health insurance company. The only thing I saw was a law dating back to 1996 with the standard medical and less standard, but not uncommon, religious exemptions. It was clear that the state does require school children to be immunized, and the exceptions are for very limited cases; also that this is the way the law has been for more than 10 years. Here's the result of my exploration of the Illinois site:
On the Illinois state site, it looks like immunizations are absolutely mandatory for children entering school. There are 2 possible exemptions -- either for health (e.g., if a child is immuno-suppressed that might mean a medical exemption, but only if this is stated officially by a doctor), or parental objection -- and this must be, quite specifically a religiously-based objection:
http://www.ilga.gov/...
Section 665.510 Objection of Parent or Legal Guardian
Parent or legal guardian of a student may object to health examinations, immunizations, vision and hearing screening tests, and dental health examinations for their children on religious grounds. If a religious objection is made, a written and signed statement from the parent or legal guardian detailing such objections must be presented to the local school authority. The objection must set forth the specific religious belief which conflicts with the examination, immunization or other medical intervention. The religious objection may be personal and need not be directed by the tenets of an established religious organization. General philosophical or moral reluctance to allow physical examinations, immunizations, vision and hearing screening, and dental examinations will not provide a sufficient basis for an exception to statutory requirements. The local school authority is responsible for determining whether the written statement constitutes a valid religious objection. The parent or legal guardian must be informed by the local school authority of measles outbreak control exclusion procedures in accordance with the Department's rules, Control of Communicable Diseases Code (77 Ill. Adm. Code 690) at the time such objection is presented.
(Source: Amended at 20 Ill. Reg. 11950, effective August 15, 1996)
My question is: is the company's refusal to pay the result of one misguided insurance clerk, one misguided office of an insurance company, or is it a company-wide policy being implemented to cut (short-term) costs, or even worse -- something that cuts across insurance companies?
I would really appreciate any Kossacks who have any experience with this particular problem (or their family/friend's health insurance company) of the insurer claiming that childhood immunizations are "elective" in order to avoid paying, to please tell me in the comments -- what happened, when it happened and info on the insurance company.
At this point, all I have is sherlyle's experience -- with "United Health" from the employer Caterpillar. I assume that's the United Healthcare, which Nyceve cited in her excellent recent diary as a particularly bad insurance company (and that's saying something!):
http://www.dailykos.com/...
If this is a more widespread problem, it would be really good to get info on it. Thanks!