Financial, Insurance, Synagis help?

sallypilot

Any advice on how to deal with the insurance paperwork, claims, and bills?

We just brought our son hom from the NICU last week and I have started to try and sort through the bills. Also, the pharmacy that our doctors office uses is telling me that i have to pay them upfront for the Synagis ( $2000) per shot before he can get it because of our deductable. 

Any advice would be appreciated. 

THANKS!

Sally

luckycooky

Did you start a new insurance "plan year" since DS was discharged from the NICU?  If not, I would question it because the NICU will generally be more than any deductible.  If it is, the plan you have may be similar to one offered at my work where you pay your deductible then it goes 80/20 and you only pay 20%.  I would double check with your insurance company because the pharmacy may not be as familiar with your specific plan and previous treatments.

We found that everything was billed separately even though it was all from the same clinic/hospital group.  The best thing we did was combine as many of these as possible so we had fewer accounts to track.  I also purchased an accordian file to keep all of the paper work.  A file for each account and the very wonderful "paid" section for all of my receipts.  (Hello tax deduction!)

chickaboo1974

Call your insurance provider. 

Synagis is a specialty drug, and your insurance company will have a speciality pharmacy that is on their preferred list.  My Peds office works with your speciality pharmacy, but you can arrange it also.  Once you know that your child is approved for coverage of Synagis and you work with the insurance's speciality pharmacy- having the script sent to them (I have never had to put any money out).  They ship it directly to the peds office.

LuckyMom0203

Blugh-- this is the worst.  We just went through it ourselves.  Our insurance said they would cover her round of Synagis but our coinsurance payment was $844 PER SHOT.  And of course we would have to pay before they would ship the shot.  We got assisstance from two different places:

1)  MedImmune, the maker of Synagis, mailed us a card that, once activated, takes $225 off each shot.  To get this card, I simply called our pedi and the nurse sent me one.

2)  There's a copay assistance program you can apply to-- I'm not sure how it works if it's technically a deductible-- but anyway, we applied and heard back fairly quickly and were awarded the minimum assisstance which was $1500.  The paperwork is minimal and the process is easy and quick.  Also, the qualifications for who can qualify are pretty liberal.  The website is:

https://www.panfoundation.org/

 They sent us a card in the mail.  We were able to use this plus the card from MedImmune to get her shots going.  

I hope this helps and good luck!!