RSV Immunization Blocked by Insurers at US Hospitals

WASHINGTON — RSV immunization for newborns is falling through the cracks at American hospitals, where most health insurers refuse to pay for the shots, NPR reported on October 16. The monoclonal antibody doses cost about $500 each, and insurers generally will not reimburse hospitals for administering them before discharge. Instead, RSV immunization coverage is typically limited to pediatrician offices, creating a dangerous gap between birth and a baby's first checkup. RSV remains one of the most common reasons infants are hospitalized in the United States. Dr. Michelle Fiscus, a pediatrician who serves as chief medical officer of the Association of Immunization Managers, told NPR that the best way to protect babies is to immunize them within the first seven days of life — preferably before they ever leave the hospital. The reason is simple: once newborns go home, they are immediately exposed to the virus during respiratory season. Yet many hospitals do not routinely offer the RSV antibody shots before discharge. Fiscus said a sizable share of babies never make it to their first checkup within the seven-day window, leaving those infants without newborn RSV protection at the moment they need it most. That reality makes the RSV immunization debate one of the most pressing infant health issues of the season. ## Why RSV Immunization Is Not Covered in Hospitals The dispute centers on how birth care is billed. Hospitals typically negotiate bundled insurance payments covering delivery and newborn care, and not every infant needs the shots — babies whose mothers were vaccinated against RSV, or those born outside RSV season, may not require them. Because of that, most insurers say the RSV antibody shots belong in a doctor's office visit, not the hospital bundle. Fiscus disputed that reasoning. She told NPR that many eligible babies are not getting protected in time, calling the gap "pretty big." Parents can get the shots for free from a doctor's office, but the journey from hospital to pediatrician often takes longer than the seven-day window during which early newborn RSV protection matters most. ## RSV Immunization Costs Strain Hospital Budgets At roughly $500 a dose, hospitals say they cannot absorb the cost of universal in-hospital RSV immunization without reimbursement. Some facilities have opted out of offering RSV antibody shots entirely rather than billing families directly, while others reserve doses for the highest-risk infants. Enrolling in a federal program that supplies childhood immunizations for free could help hospitals offer the shots, but the American Hospital Association told NPR that the program does not resolve the underlying insurance dispute over who pays for in-hospital administration. ## The Fight for Infant Health Continues America's Health Insurance Plans, the trade group for commercial insurers, said in a statement to NPR that its members are fully committed to providing RSV protection for babies. But the group said insurers are not required to pay for the immunizations in hospitals — only in doctors' offices. Pediatricians continue to urge parents to ask hospitals about the shots before discharge and to seek them promptly at the first visit. For now, the battle over RSV immunization payment leaves many families caught between medical advice and insurance rules — and infant health advocates say the fix will require changes to bundled-payment rules or broader in-hospital coverage, so that newborn RSV protection begins in the nursery, not weeks later.