Synagis shot- should I worry?

The Ped. recommended they get the Synagis shots to prevent RSV, esp. since we're in the winter/flu months. However, my girls were born at 35W + and the insurance co. denied the coverage. Should I be worried?

Has anyone had experience w/this? fighting it, not getting it, etc? I don't know enough about it, and I am trying my best not to google it, lol.

Re: Synagis shot- should I worry?

My ped didn't recommend getting it since my girls didn't go to day care. They were born at 35w4d on Nov 5 last year. I didn't take them out of the house for anything besides dr appts until they were 3.5 months. They got their first sniffle a week before 11 months.

Re: Synagis shot- should I worry?

No i wouldnt be too concerned. Insurance companies hardly ever cover it unless the babies are under 32 weekers or have lung issues. If they covered it I would say yeah go ahead and get it, it definitely cannot hurt, but to pay out of pocket is crazy. I believe its something like $1500 a shot, that would be x2 for you and the RSV season is 6 months long.
Last year my triplets received it for the 6 months (they were 30 weeks with 2-2.5 months in the NICU). This year my doctor told me to put it into insurance and see if they cover it (they are 17 months now), somehow insurance covered 1 of my boys and not my other DS or DD. The doctor said there seems to be no rhyme or reason...my DS who is covered is actually the healthiest, the largest, and the least about of issues. Go figure. I will get him the shots this year just because it is covers, but I am not arguing for my other 2. And we are out in public all the time.

Re: Synagis shot- should I worry?

I'm sorry the insurance company denied them, but I am not surprised. I have heard of a lot of people having difficulty getting insurance to cover Synagis because it is sooooo expensive per shot and you usually get 5-6 shots through RSV season. I don't get why they don't just approve them for any baby that is higher risk :( I am pretty sure you can appeal the decision. It can't hurt to try. The worst thing that will happen is they still say no.

My twins were approved for Synagis last year because they were 27weekers. DD came home during the start of RSV season and DS was still in the hospital dealing with his respiratory issues. This year they were both actually approved again even though they are over a year old because DS has severe respiratory issues (he has a trach because of the chronic lung disease due to prematurity). I knew he would medically qualify this year, but didn't think DD would because she has been healthy. However, the doctor's office put in the justification that she should have the shots so she doesn't carry RSV to DS. Even with the shots, we were pretty much put on "quarantine" from October through March. We were told no malls, stores, large gatherings of people esp where there are a lot of kids. Be extra careful that you and other family members wash their hands before touching them. Make sure no one is around them that has or recently had symptoms of a cold or anything like that. We had all of our immediate family members get the flu and whopping cough shots. After DS spent the first 8 months of his life in the hospital (most of that time on a ventilator), I don't want to do anything to risk him having a major set back.

I am not saying you have to be as crazy as we are bc obviously our situation is different. However, I wouldn't worry if they don't get approved for Synagis, just use your common sense and try to keep them as healthy as possible