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Considering the RSV shot - Page 3

post #41 of 50
Quote:
Originally Posted by Khourtniey View Post
Well Its either 1,200 a month for approx 4-6 months or 1,500 - 3,000 per day for a 2 or 3 week PICU stay if the baby does get RSV... I think more insurances would pay for it rathen than wanting to rsik a larger bill.. but thats not always the case... I could give you many stories of the silly things insurances do.

FWIW You can appeal the decision if you are denied.
We just got the final pay out for our 10 day hospital stay for RSV (2 days were in the IMC/PICU). It cost $65,000 and that was without any sort of advanced respiratory support!
post #42 of 50
Quote:
Originally Posted by Khourtniey View Post
Last year it was pretty tough to qualify because Alo (my middle child) was 2.5 at the time.. The cutoff age is normally 2 unless there are other medical issues.. Even with him being on a ventilator, oxygen, trach, etc he still had trouble qualifying.. This year we are going to have a really tough time qualifying but we are fighting like crazy for it.
We're working to get approval for Dakota's 3rd full season of Synagis. She was denied off the bat due to age (2.5yrs) but we're appealing. She has significant lung damage, is oxygen dependent, requires a vibrating vest, breathing treatments q4hrs and even the simple cold puts her in the hospital. I am hopeful, based on what the pulmo has said, that we'll be approved but still worried we may not be. It's great to hear others have fought and won!
post #43 of 50
Quote:
Originally Posted by irangel View Post
We're working to get approval for Dakota's 3rd full season of Synagis. She was denied off the bat due to age (2.5yrs) but we're appealing. She has significant lung damage, is oxygen dependent, requires a vibrating vest, breathing treatments q4hrs and even the simple cold puts her in the hospital. I am hopeful, based on what the pulmo has said, that we'll be approved but still worried we may not be. It's great to hear others have fought and won!
Last year we were denied because of the age... They didnt even look at the medical problems. Just automatically said he is too old.. But he had trach, vent oxygen, IPV, etc.. The year prior to that he did not have his trach and stuff but they denied him because he "should be off of the oxygen by now according to his age blah blah blah".. Mind you, he was still on oxygen and in the hospital. He is now 3.5 and this will be his 4th year if we get it. He still has his trach, vent, oxygen and stuff

It just makes no sense that they wont even look at the medical reasons .. I guess they just think most parents wont even fight it.. or at least hope they wont.
post #44 of 50
We did not vax, but we did do the RSV shot (Synagis) from about October through June for both of them. It did its job and I was extremely grateful for that as it was a terrible season where we lived. Insurance was not a problem, thank goodness - it was around $2000/month.
post #45 of 50
we just got a denial letter for the synagis. she will be 6m 2 days too soon.
post #46 of 50
I'm having problems with my insurance too.

Ds was born at 35 weeks, was vented 3 different times, had a week and half NICU stay and has already been hospitalized again after coming home, he is 5 weeks old.

He recieved his first Synagis shot the day he discharged from the NICU. His next shot is due Monday and my insurance won't cover it.

I have 2 older children in school, another in daycare, and he will be starting daycare by the first of November.

My 3 and 5 year old were hospitalized at the same time last October AND the October the year before. My 5 year old had Pnuemonia both times and my 3 year old had Pnuemonia and RSV both times.

His immune system is very weak and has other medical problems.

AND THEY STILL WON'T APPROVE IT!!!!!!!!!!!!!!!!!!!!!!!!!
post #47 of 50
Quote:
Originally Posted by mommy2maya View Post
we just got a denial letter for the synagis. she will be 6m 2 days too soon.
It's not uncommon to get initial denial letters but often times an appeal gets the job done. Persistence is key with insurance companies.
post #48 of 50
Quote:
Originally Posted by justme&my3+1 View Post
I'm having problems with my insurance too.

Ds was born at 35 weeks, was vented 3 different times, had a week and half NICU stay and has already been hospitalized again after coming home, he is 5 weeks old.

He recieved his first Synagis shot the day he discharged from the NICU. His next shot is due Monday and my insurance won't cover it.

I have 2 older children in school, another in daycare, and he will be starting daycare by the first of November.

My 3 and 5 year old were hospitalized at the same time last October AND the October the year before. My 5 year old had Pnuemonia both times and my 3 year old had Pnuemonia and RSV both times.

His immune system is very weak and has other medical problems.

AND THEY STILL WON'T APPROVE IT!!!!!!!!!!!!!!!!!!!!!!!!!
That's so so so frustrating! I would definitely push your doctor to appeal the decision.
post #49 of 50
Hopefully Numax will be out soon. That is the new drug to replace Synagis. I think it's made it through phase 3 clinical trials now. The cost per shot would probably be comparable but it will only need to be given every 60 days. Overall the cost would be half of what it is now so maybe it would be easier to get insurance companies to pay it. I also think it is supposed to be for a larger market (elderly and high risk patients).

My 32 week twins got the shots through December. We moved and the new insurance company denied them because they were over 6 months old. I didn't even think of trying to appeal. Fortunately they didn't get sick the rest of the winter.
post #50 of 50
our DD was also born at 35wks, so this is something we wil be considering also, even tho we don't vax.. but we still have soem more reaserch to do
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