Billing for Vaccination in Schools: Experience From a School-Based Tdap Vaccination Clinic

Background: Schools are a promising venue for adolescent vaccination. Few school vaccination programs have billed health insurance for vaccines given, which may hinder long-term sustainability.

Objectives: 1) to assess the feasibility of a school-based vaccination program, open to all students regardless of insurance status and capable of billing health insurance companies for vaccines and administration fees; and 2) to assess vaccination and billing outcomes of the program.

Methods: In April 2009, a tetanus-diphtheria-acellular pertussis (Tdap) vaccination clinic was held in a public middle school. School personnel obtained parental consent, and local public health personnel verified insurance information, conducted the clinic, and performed billing. Vaccines from the Vaccines for Children program were available for publicly insured and uninsured students. Parents did not receive bills if insurers denied submitted claims.

Results: Of 909 enrolled students, 446 (49%) had no documentation of Tdap vaccination. Of students needing Tdap, 155 (35%) had consents for vaccination. Of students with consents, 151 (97%) were vaccinated during a single, 2.5-hour vaccination clinic, and school-wide Tdap vaccination coverage increased from 51% to 68% (p<0.001). Thirty percent of vaccinated students were privately insured, 5% were insured by the Child Health Insurance Plan, 25% were insured by Medicaid, and 40% were uninsured. For the 45 privately insured students, 51% of bills for vaccines were reimbursed (median reimbursement $36.25/dose), and 29% of bills for vaccine administration fees were reimbursed (median $7.00/dose). The most common reasons for unreimbursed claims included: no response from insurer (n=7), charge was the patient’s responsibility (n=6), insufficient information provided (n=3), and absence of a referral (n=3).    

Conclusions:A school-based vaccination clinic which included insurance billing significantly increased school Tdap vaccination coverage, and vaccinated students with private, public, and no insurance. Because only one-half of bills for vaccines were reimbursed by students’ private insurers, additional billing processes will be needed to ensure the financial sustainability of similar programs.