I thought my LO would get synagis??

WannaBAmama

I found out he was denied. He was born at 34 weeks, will be under 3 months at the start of RSV season and has a 3 year old brother that goes to preschool. I thought he would meet with those qualifications. Here's my question how do they find out that information?? I was told at the pedis office a man from the clinic would call me and we would go over if he qualifies or not...I thought at that point I would be able to tell him he has a brother in preschool and will be going to an in home provider just grandma : that watches other children in preschool. That never happened, I just went to my last pedi appointment and they said oh he was denied. So are they strictly going off of his birth age or what?? I never talked to anyone about our family life or about him having an older brother. Is that not being taken into consideration? My pedi said they wrote an appeal letter and are waiting to hear back. I think I might call back tomorrow to get more info, id like to write my own appeal letter. The doctor office is doing this whole thing without talking to me about any of it. I had no idea we were denied and an appeal was sent. I just want to make sure the insurance company has ALL the information needed to make their decision.
It sucks, we have great insurance. My husband works for the Cleveland clinic. We paid 50 for my csection and LOs 16 day nicu stay. I thought they would for sure cover this for him

Kadyra

There was a really great appeal letter posted maybe a week ago. I think it's great to write your own letter in addition to your pedi's. GL!