December 18, 2002

KNOXVILLE, Tenn.- Questions about insurance coverage have some state health care workers waffling on whether they will receive smallpox vaccinations.

A memo circulated in at least one Knoxville-area hospital last week questioned whether private insurance will cover medical treatment for side effects suffered by volunteers who receive the vaccine.

"Right now, my insurance company is a bigger threat to me than a terrorist is," one hospital worker, who asked not to be identified, told The Knoxville News-Sentinel.

About 2,500 public health workers in the area will begin getting vaccinated by the end of next month. In addition, the government has asked to vaccinate teams of volunteers from every hospital.

The Tennessee Department of Health said it would offer the smallpox vaccine to about 20,000 emergency workers across the state, according to the outbreak response plan it submitted to the federal government.

Insurance providers said the concerns raised by emergency workers are overblown.

Cariten Healthcare, which provides insurance for the majority of hospital workers in the Covenant and St. Mary's health care systems, will cover treatment for any side effects of the vaccination, said Suzy Hanson, Cariten's director of medical management.

"Cariten Healthcare benefits provide coverage for the complications that may arise from receiving an immunization or vaccination," Hanson said.

A spokeswoman for Cariten said side effects from the smallpox vaccination will be covered just as any other immunization, such as the flu shot, would.

"We wouldn't make a differentiation" between smallpox and other vaccinations, she said.

Smallpox is a highly contagious and sometimes fatal infectious disease. There is no specific treatment and the only prevention is vaccination. The vaccine also can lessen the severity of or even prevent illness in people exposed to smallpox if given within three to four days of exposure.

About 1,000 people out of every million vaccinated become sick. Extreme discomfort, including fatigue, fever, loss of appetite and other flu-like symptoms, can occur after the vaccine is administered and last a few days.

Insurance companies said workers would not have to worry about costs if they become ill.

"Any side effects that one got from a vaccination that would require physician or hospital services, those would be covered by benefits," said Frances Haman-Pruwitt, spokeswoman for BlueCross/BlueShield, which provides health-insurance coverage for a majority of workers in University Health System.

And Ellen Hooper, account manager for United Medical Resource, which covers workers in Baptist Health System, said side effects of any adult immunization would be covered.

"We wouldn't single out smallpox," she said.

Still, there may be good reason for workers to have some doubt. Private insurance companies across the country are evaluating their responsibilities where the vaccine is concerned.

"Personally, I'd be very surprised if the insurance company would pay for it unless it was mandated," said Martin Unger, a broker with Tennessee-Insurance.com, an online health-insurance agency covering four states.

While the Homeland Security Act addresses liability, specifically saying health care providers _ individuals or companies _ cannot be held responsible for side effects suffered from the vaccine, compensation is not addressed clearly.

Section 304 of the act states individuals can file a claim against the federal government if injuries result from a smallpox vaccination, either from having the vaccination or from coming into contact with someone who has had it. If the claim is denied, or no action is taken within six months, the individual can sue the federal government.

Proving negligence, however, would be difficult.

Some in health care administration believe injury from having the vaccine would most likely be handled through workers' compensation.

"I'm not sure that we believe it is going to (be) a health insurance situation but rather will be workers' comp," said Betty Gissel, vice president of human resources and payroll for University Health System.

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On the Net:

Tennessee Department of Health: http://www.state.tn.us/health/