Staff Shortages:
All of healthcare – locally and throughout the country have shortages in healthcare offices and hospitals. If you are getting care at hospitals, you will notice that it is taking longer to get a phone call answered or an issue taken care of. There is a lot of mobility and movement from staff and nurses in healthcare and each time this happens it reduces efficiency in the office someone leaves from (recruit and train another person) and in the office they jump to (needs to be trained on processes and procedures by another staff member). At Four Seasons Pediatrics we work hard to retain our staff but are subject to the same shortages. As we get back to full staff, we need a period of training which is affecting workflow. We are also experiencing an outbreak of COVID among staff. As soon as that began, we started isolating and testing staff who have no symptoms to limit any spread. We have done a great job in that regard. None the less, as we identify and protect our patients and our staff through early detection, most staff will be unable to enter our building for 10 days due to continued restrictions on healthcare workers as recommended by the CDC. This has a huge effect on our office, and as such we have limited nurse visits for the products you will read about below. We will offer more when we can but will offer these products when they are in and during your routine office appointments. We appreciate your support and thank you for your understanding.
RSV Monoclonal Antibody Immunization
RSV (Respiratory Syncytial Virus) is a leading cause of illness in children. It is responsible for 100-300 deaths in children and up to 85,000 hospitalizations per year in the US. Almost all children get RSV at least once by age 2 and it is the leading cause of hospitalizations for children under 1 year of age, affecting those under 6 months most severely. To read more about RSV and prevention options click here. We do not have antiviral medication for RSV and other treatments like steroids are not effective. Up until this point, we have not had a vaccine for children (vaccines raise immunity by allowing our bodies to produce its own immunity), but there has been an immunization (supplies immunity but in this case is passive immunity) that gives temporary protection by supplying instant antibodies. This is called Synagis and it is called a monoclonal antibody. This immunization lasts about a month, is given monthly for 5 months and typically costs more than $2000 per month. It is only used for extreme high risk.
There has also been a vaccine that has recently become available for pregnant mothers and for the elderly. Availability and insurance coverage vary for pregnant mothers. The vaccine for mothers will offer protection for the first few months of a babies life (passive immunity). There is a vaccine in development for babies (active immunity and more long lasting).
As some of you have heard, a new monoclonal antibody has been approved and Four Seasons Pediatrics Pediatricians are very enthusiastic about the impact this will have on RSV. Dr. Miller was recently interviewed regarding this immunization for a statewide story on Spectrum News. Unlike Synagis, this will be given for all infants under 8 months of age and for those from 8-19 months for those at higher risk. It is given as one dose and will last 5 months. We have been pressing insurance companies to find out if they are covering and paying for the full cost for it. We finally heard from some of them by the end of the first week in October (last week). If your insurance is not listed below, we encourage you to call them and let them hear your voice. Tell them you want them to let our office know that they are covering it and paying for the full cost. It is our hope that they will consider this a preventive service and not apply a cost share or deductible for it.
Update 11/1/23 – we have learned that there is unlikely availability of the Immunization and we cannot guarantee that we will have it on any given day. We therefore will only be able to offer this injection if a family is present and we have it in stock. If it becomes more available, we will let you know.
• Aetna
• Anthem/Empire Blue Cross ** – Requires prior authorization
• CDPHP
• Cigna
• Highmark
• Empire Plan (NYSIP)
• MVP Healthcare
• United Healthcare.
At this time, this leaves Tricare. We have heard from other practices in the US that Tricare has applied coverage to a deductible. We feel that this is incorrect for a preventive immunization and are verifying this.
Though much less expensive that Synagis noted above, this is the most expensive injection Pediatricians have ever given, so we will ensure insurance coverage at the time of the visit.
Seasonal COVID Vaccine
We have received Seasonal Pfizer COVID vaccine. This is no longer a government supplied vaccine. We have received this vaccine for all ages. We believe that all children under 5 should receive this vaccine. Among children, this group is at highest risk due to lack of immunity to COVID.
For those over 5, immune protection is much better for those who have had a previous COVID vaccine and or those who have had COVID infection. Many of you have asked – “Should my child/young adult get a booster of this seasonal vaccine?”. This will be an individual decision based on a number of factors:
• Is my child/young adult at higher risk due to chronic disease, or immune deficiency?
• Are they around those who are at high risk? What will your Holiday visits look like? Many infections are fueled by being back to school and spread of COVID during the school year/daycare settings.
• What is the community rate?
• How do I feel about reducing the chance of infection, loss of school time etc.
Safety of COVID vaccines
The current seasonal vaccine is monovalent (has one strain more closely matched to the Omicron variant currently circulating). There was a concern about young males (16-24) having myocarditis after the vaccine. This concern was much higher and more severe with the COVID infection itself. The risk for myocarditis was 0.007% after the original vaccine and was higher with Moderna vaccine. The risk of myocarditis after infection is 0.02% and the myocarditis was more severe when present. The Omicron strain appears to have a much lower probability of causing this problem, and therefore the Omicron based vaccine should be lower as well. If you feel that you/your child are at higher risk of COVID, we feel that this is a safe vaccine to give and the infection itself has more risk than the vaccine.
Insurance coverage of the Seasonal Vaccine
The coverage of the Seasonal COVID vaccine is now in the private sector. As of 10/19, we can confirm coverage from these insurance companies:
• Aetna
• Anthem/Empire Blue Cross Blue Shield
• CDPHP
• Cigna
• Highmark
• MVP Healthcare
• NYS Empire Plan (NYSHIP)
• United Healthcare.
As of 11/1/23 we are still waiting on coverage decisions from Tricare. If your insurance makes a decision to not cover the vaccine (we feel this is highly unlikely), you would be eligible to get the vaccine through the government program called VFC (Vaccine for Children). Please note – if your insurance decides to put this into a deductible – that is not eligible for VFC. This is more likely with an employer sponsored self insured plan.
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