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Synagis and insurance...

renee6465renee6465 member
in Preemies
Ok quick question I figured you ladies would know the answer to.

I had the doctor put in to have the shot pre authorized through insurance. Insurance of course denied it. I THINK they denied it because LO will not be 90 days or less at the start of RSV season or at the time of the first dosage. Those are two of their qualifications for the vaccine.

My question is should I appeal this? I'm not really sure what that means, the lady I talked to from the insurance company said I could. I just don't know if it would be worth it, or if they are going to budge at all. Anyone have any experience with this? Insurance confuses the crap out of me!
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Re: Synagis and insurance...

  • kck329kck329 member
    BostonKisses2 said:
    Appeal.  It's possible they may deny it again, but with something like this it's always worth it to appeal their decision.  I'd recommend calling your pedi's office and ask them if your pedi already started the appeal process, or if they can start it.
    This. And if your LO sees any specialists (pulmonary, cardio, etc) then ask them to appeal it as well, that often gets good results.
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  • renee6465renee6465 member
    He doesn't see anyone extra just the pedi. I'll call them tomorrow and talk to them! It's just so annoying I don't understand why insurance has to be such a pain in the arse and it sucks they get to decide what is "medically necessary".
    BabyFruit Ticker
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  • [Deleted User][Deleted User] member
    If you have insurance through your employer and you employer is a llrge company, often the people who participate in insurance have participant advocacy. This is a service that your company pays for to assist in complicated claims and the like...maybe they could help?
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