Synagis

Missa_g

Our pediatrician said our boys likely won't qualify but I'm finding conflicting information online.  It looks like babies born at 29w gestation after mid March of this year should qualify.  Does this sound right?  I haven't found anything through google that looks official though.

Belleza907

My girls were born May 30, 2011 at 29 weeks 4 days and they qualified for Synagis shots all through last RSV season.

Pips09

I was told that the minimum requirements to qualify were that a child had to be born at a gestational age of 30-32 weeks and would be under 6 months of age at the start of RSV season, or under 30 weeks gestational age at birth and under a year old at the start of RSV season. Those are just the minimum requirements, I've found that the actual qualification is highly subjective. If the doctors/insurance think your boys are doing well and don't need the extra help, they may not approve the treatment. I know a lot of people on here have had trouble getting the approval.

Missa_g

Belleza907:

My girls were born May 30, 2011 at 29 weeks 4 days and they qualified for Synagis shots all through last RSV season.

Wow, our kids were born at exactly the same gestation almost exactly a year apart.  How did you go about getting the shots?  I'm looking for a new pedi more familiar with preemies right now since ours seems pretty clueless sometimes.

adrielegorburu

In my experience qualifying for Synagis has a lot to do with your insurance, your doctor and your state - DD was born at 22w 5d - we didnt have trouble getting approved for her first year of shots - during the season a report came out that stated 6 synagis shots were just as effective as 8 so we had our last two cancelled - we tried to get her re-approved for next year and we were denied. Although shes healthy, she has chronic BPD and is in daycare - you would think they would approve her but we tried and tried and I gave up - good luck

 

urbanflowerpot

Pips09:

I was told that the minimum requirements to qualify were that a child had to be born at a gestational age of 30-32 weeks and would be under 6 months of age at the start of RSV season, or under 30 weeks gestational age at birth and under a year old at the start of RSV season. Those are just the minimum requirements, I've found that the actual qualification is highly subjective. If the doctors/insurance think your boys are doing well and don't need the extra help, they may not approve the treatment. I know a lot of people on here have had trouble getting the approval.

This is the correct information. In your PP you mention being the same GA as another baby but that won't matter. If LO isn't under six mo actual by RSV season (when it begins could be different than were PP is, too) you'll have to appeal, but it is unlikely. DS was born 26 Mar 11 and we didn't qualify - he got bronchiolitis a few times that season (my pedi doesn't test for RSV because it's all treated the same) but he got through OK. It's scary, especially as the season gets closer and more people start talking about it along with quarantine.

The shots are extremely expensive so they are strict with them.

I'm sorry - never the answer any of us wants to hear. I was pretty bummed last year. 

Mrs. Alice

You aren't alone if you have to "fight" to get them qualified for Synagis.  I've heard others have insurance deny it because it is really expensive (like $1000/shot).  We were lucky and received it Sept-April with no issue through their SSI Medicaid coverage. 

DrRx

You could also call your insurance company and find out what they require.  They should follow the AAP guidelines, but they may have other requirements, etc.  

  We had Adalyn's 6 month appt (and shots) today, and the nurse told me that she's already started the paperwork for her Synagis and that it probably won't be until October, since that's the earliest that the insurance will approve it. 

Granted, my little girl was born at 26 weeks and was sent home on oxygen, so she has pretty much most of the automatic qualifiers. 

 

thishappyhouse

My daughter is on the cusp of qualifying (25 weeker that will turn 1 the last week of October)... we will see what the actual AAP and CDC recommendations are this year.  Our pediatrician, who I trust implicitly (former neo at a large university hospital), doesn't think she needs it.  I very much disagree and am going to continue to push that she gets it.  Our pedi moved up our cardiology appt for the fall to see where her pulmonary hypertension is.  

 Alll this to say is that it seems like it all depends on your insurance and how hard your pedi & specialists push for approval.   

kdp2008

Our little guy was 30w 6d and our doctor said that he qualifies.  We have BCBS and it will be  covered.

Our doctor was recommended to us by our NICU doctors and sociall workers and we really like him so far.  Maybe give your NICU a call and see if they have any recomendations.