Synagis question

AustinGurl

Has anyone had success getting any additional assistance getting the Synagis shots covered?  My insurance only covers them at 70% and I understand they're very expensive (like $1000-2000 each?).  I have a lot of literature from the hospital that includes some additional financial assistance, but I'm wondering if any of you have experience with that?

graciousmeg82

I have not had that problem (fingers crossed) All of our 5 Synagis shots were all pre-certed and approved by Personal Choice.  Our Pedi advised us that the rep gave the office a few samples and he would like our DD to get atleast 1 if not 2 more.  As if they can get a sample from the drug rep.  Doesn't hurt to ask. 

urbanflowerpot

AustinGurl:

Has anyone had success getting any additional assistance getting the Synagis shots covered?  My insurance only covers them at 70% and I understand they're very expensive (like $1000-2000 each?).  I have a lot of literature from the hospital that includes some additional financial assistance, but I'm wondering if any of you have experience with that?

I think a couple people have but it was under some pretty extreme circumstances. Most of us who didn't qualify were denied, period, end of discussion. There is a mom on here whose daughters lungs both collapses and she was denied. It's harsh.

Piper345

They are actually $5000 each...

Our insurance (Blue Cross) covers them at 100%. DS was born 30w5d back in last May and had no lung issues.

A friend of mine had a 35 weeker in June with no lung issues, and also had them covered at 100% by Aetna. She has an older toddler at home so the pedi claimed she was at risk.

 

kck329

I think the first step is to appeal the insurance decision-many moms here have had luck with that. Your LO is still in the NICU right? Have the neos appeal it if they want him to get synagis this season. You'll have to reapply for next season anyway.

And FWIW, in Texas RSV season ends in March so I'm guessing you will only be home for the last month of the season. We were approved for shots from Nov-March and will have to reapply if the pedi wants her to get them in April. (We are in Houston)

BritanyV

We have Blue Cross and are covered at 100%.

 

I agree with PPs about trying to appeal with the insurance.

Pips09

If I'm reading your question correctly, your insurance has approved the coverage for the shots, but the plan you have only covers this type of medical treatment at 70%. Since they have approved it, they are already paying for it at their maximum allowed benefit, there's nothing to appeal. They won't pay more than your plan states they will.

The only sure way to get the additional 30% covered would be if you had secondary insruance. Otherwise, you will be responsible for the 30% coinsurance, just as you would be for other types of medical treatment in this category. I'd look into whatever literature your hospital gave you, they may have some sort of payment plan available.