Who Gets Stuck?

"I have to pay for nursing time, supplies, syringes, alcohol pads, dropped doses and time to explain it," Lessin said of the ancillary costs of providing vaccines. "And when insurance companies decide to pay me $122 per dose and take three months to pay, I can't afford to do it. For insurance companies that are paying me $140 or $150 a dose, I'll give it." In other cases, Lessin said, he is giving patients a prescription to be filled at a pharmacy and administering the vaccine for a $25 fee.

His patients, Lessin added, "understand this."

Ahlstrom said her partners have agreed to give Gardasil to patients who belong to NCPPO, the only plan in which her practice participates. The remaining two-thirds of her patients must pay for Gardasil shots upfront.

"I feel it's a really unfair situation to put pediatricians in," she said, adding that her partners decided they would not give Gardasil at a loss. Most parents, she added, are unaware that "doctors all the time give vaccines we lose money on."

Christina Sprague of Northwest Washington said she has spent several hours on the phone in recent months trying to find a doctor who will immunize her daughter, who attends an out-of-state college.

"It's been pretty frustrating," Sprague said. "This should be straightforward."

Linda Woolley, a lawyer who lives in Chevy Chase, said she called four doctors' offices in the District and Maryland recently seeking one that had the vaccine, which officials at CareFirst BlueCross BlueShield told her was covered under her plan.

None did, but a doctor in the office of Woolley's OB-GYN, Mark Reiter, wrote a prescription and agreed to give the shot to Woolley's teenage daughter. But after Woolley spent $181.99 for the first dose of the vaccine from CVS, CareFirst rejected the claim, saying it wasn't covered because the vaccine had not been supplied by a physician.

Reiter said his practice, one of the city's largest, doesn't buy Gardasil because the $2 reimbursement rate quoted by insurance companies "isn't worth it."

Woolley regards her situation as a Catch-22: "I find it curious that states are mandating this" but consumers have trouble getting the vaccine.

CareFirst spokesman Jeff Valentine said the company has received several similar complaints from subscribers and is looking into them.

"We are in the process of examining our rates," said Valentine, adding that several physicians have complained about low reimbursements. But he said that CareFirst, one of the largest insurers in the metropolitan area, is "competitive with what other insurers are paying," although he declined to discuss fees. Recently Cigna and UnitedHealthcare announced they were raising reimbursement rates for Gardasil.