No more synagis shots for Grayson

ajordan83

I got a phone call from the drs office saying that the insurance wasn't going to pay for synagis anymore!!!  They said because he's now 90 days old they dont think hes at risk!  what the heck!! He's a 32 weeker with brothers in school and he goes to daycare!!  he's only one month adjusted for petes sake!!! 

 GRIPPPEEE!!!!

 thanks for letting me vent!

JeepersWife

Mine only covered one shot...and we're on an apnea monitor...and DSs cousin (who he stays with during the day under the care of my mother) already was diagnosed with RSV...

 

urbanflowerpot

Wow, they're ruthless. It never occured to me that if a child grew out of the requirements during the season they'd stop the shot. Seems like something they'd tell families who are on the cusp. I'm so sorry!

Welcome to my boat

lwmooney87

I think it's a load of crap, if you ask me. Reagan wasn't covered either...not even for one! She's a 29 weeker and had both lungs collapse at birth but they say she's not "at risk". The nurse at our Ped's office said that they used to approve ALL babies born prematurely. I guess with rising health care costs, they have to be more strict about it. What I don't understand is, they would rather our preemies get RSV and be hospitalized? I would think that would cost TONS more. It doesn't make sense to me.

I'm sorry they only covered one. He seems awfully young for them to not cover it. So stupid.

adrielegorburu

That sucks royally! I was upset when they told me DD wouldnt qualify for next year, at least they are paying for it for this season. Its seems like a no brainer that all of your LO's should get it! It would certainly cost the insurance more if they were in the hospital for RSV then to just pay the shot! so sorry guys

bhilyer

I would file an appeal.  I'm sure you could get a letter from your pedi and the NICU stating WHY your LO is at risk.  

MommynTeacher

This makes me sick! Insurance companies have no soul

urbanflowerpot

lwmooney87:

I think it's a load of crap, if you ask me. Reagan wasn't covered either...not even for one! She's a 29 weeker and had both lungs collapse at birth but they say she's not "at risk". The nurse at our Ped's office said that they used to approve ALL babies born prematurely. I guess with rising health care costs, they have to be more strict about it. What I don't understand is, they would rather our preemies get RSV and be hospitalized? I would think that would cost TONS more. It doesn't make sense to me.

I'm sorry they only covered one. He seems awfully young for them to not cover it. So stupid.

Reagan didn't qualify???? That's wrong.

lwmooney87

Nope, she didn't. They actually submitted it twice but no luck. Ticks me off.

Natalie_may

We were initially denied but after filing appeals and being generally obnoxious to the insurance company they reversed the decision.  File an appeal and continue being vocal and perhaps they will change their minds.

ajordan83

LegalPawn:

I'm kind of worried about this.  LO was given her first shot in the NICU the day of her discharge.  I didn't really think much of it until I went to the ped and had to fill out all this paperwork for the shots.  Walgreens called today saying they got the paperwork, but have yet to make a decision on whether she qualifies before sending it on to the insurance company.

I had no idea it was so damn involved.  I'm sorry, but if a neonatologist says my baby needs the shots, then she should get them.  It seems so ridiculous that there is so much red tape to prevent an illness that would land these babies right in the NICU again.  Gee, I wonder what's more expensive...

 

THIS!!  it is so involved.  They wouldn't give Grayson his first shot at the NICU because of red tape then it took a whole month more to have him qualify.  He got ONE shot.  By the time I file the appeal and do all that it will be past RSV season.  Hope my insurance is prepared for a very unhappy momma if Grayson gets RSV like his brothers did and is hospitalized!

jacksonandbradysmom

We only were approved for one shot, too. Insurance companies are ridiculous.

 

Pumpkinface19

Landon is a 32 weeker as well and my due date was yesterday. He receieved his first shot in the NICU and now is also being denied the rest. It is so frustrating! What was the point of the first shot in November while he was in the NICU if he isn't going to get anymore while he is at home, on an apnea monitor, and going to daycare during RSV season (he doesn't start until Feb/March so that is why they continue to deny him the shot). We are on our second appeal. Usually this board makes me feel better when we all have things in common, but hearing how ALL of us are being denied the shots is making me more angry. GRRRRRR insurance!