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Kissy331
My two miracles!
Member since 5/06 17826 total posts
Name:
Kristen
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WWYD: Paying out of pocket for Synagis vaccine?
So after a couple of weeks of battling with our insurance, we have exhausted all appeal processes & our little guy was denied again for the RSV drug Synagis. I am taking him tomorrow to the Ped for a check on his breathing & what not & DH told me to inquire on getting him the shot but paying out of pocket.
The shot is based on the baby's weight & the min it would be is $1200. DH thinks it is worth it for DS to get at least one shot to get us out of the RSV season considering this is his second round of RSV since Jan.
If you were in my shoes, WWYD?
Message edited 2/15/2011 9:13:43 PM.
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Posted 2/15/11 9:05 PM  |
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jinglemommy
I <3 my boys!
Member since 12/06 1389 total posts
Name:
Kelly
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Re: WWYD: Paying out of pocket for Synagis vaccine?
Personally I would pay for it......but is that an option? I am wondering if u would even be able to get it out of pocket. Kwim? Are they strict with even getting it?
I should say my son was premature and we were lucky enough to get synagis for three rev seasons. I was so happy when march came every year!
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| Posted 2/15/11 9:15 PM |
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Kissy331
My two miracles!
Member since 5/06 17826 total posts
Name:
Kristen
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Re: WWYD: Paying out of pocket for Synagis vaccine?
Posted by jinglemommy
Personally I would pay for it......but is that an option? I am wondering if u would even be able to get it out of pocket. Kwim? Are they strict with even getting it?
I should say my son was premature and we were lucky enough to get synagis for three rev seasons. I was so happy when march came every year!
When they denied him, the pharmacy end of our insurance told us that we could opt to pay out of pocket for the drug (our Ped gave us the price). Funny thing, our medical insurance approved him! He was born at 32 weeks premature & they are stating the only reason he is NOT getting it is bc he has "no chronic lung disease" yet he fits all other criteria! 
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| Posted 2/15/11 9:21 PM |
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Mommy2Boys
My Boys!!!!
Member since 6/06 14437 total posts
Name:
C
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Re: WWYD: Paying out of pocket for Synagis vaccine?
Posted by Kissy331
He was born at 32 weeks premature & they are stating the only reason he is NOT getting it is bc he has "no chronic lung disease" yet he fits all other criteria!
What about if you brought him to a pulmonologist? Maybe they would be able to give him some type of diagnosis which would allow him to get the shot.
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| Posted 2/15/11 9:25 PM |
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jmf423
:)
Member since 5/05 6372 total posts
Name:
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Re: WWYD: Paying out of pocket for Synagis vaccine?
if you can afford it i would do it. you would only need 2 shots now.
My kids were not approved (even though they were both on ventilators when they were born  ) and we fought to get them last year and our insurance wouldn't pay either. ds and dd both had rsv last year. ds was much sicker and was hospitalized for it. even after that he didn't get approved.
ask them tomorrow at the peds office what they suggest at this time of year, and being that he already had it 2 times.
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| Posted 2/15/11 9:43 PM |
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MamaB17
Back for baby #3
Member since 5/09 4065 total posts
Name:
N
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Re: WWYD: Paying out of pocket for Synagis vaccine?
I am so sorry your dealing with this. I think it is really crappy he is not approved. My dd was born at 31wks 5 days, she was approved. They said the only reason she was approved was b/c over the summer I brought her in to the ped b/c I thought she sounded like she was wheezing. Turns out that is just how she breaths. I was a new mom, and paranoid w/ a preemie. No chronic lung disease here. How many shots would you need march & april? I am not sure if I would pay for them out of pocket. They are really really expensive. Part of me feels like if you can swing it for one or two shots do it, b/c if you don't & he gets it you will be mad at yourself. You can check on the cdc website rsv trends in your area, if that makes a difference in your debate. Good luck!
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| Posted 2/15/11 9:56 PM |
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Kissy331
My two miracles!
Member since 5/06 17826 total posts
Name:
Kristen
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Re: WWYD: Paying out of pocket for Synagis vaccine?
Posted by MrsB0118
I am so sorry your dealing with this. I think it is really crappy he is not approved. My dd was born at 31wks 5 days, she was approved. They said the only reason she was approved was b/c over the summer I brought her in to the ped b/c I thought she sounded like she was wheezing. Turns out that is just how she breaths. I was a new mom, and paranoid w/ a preemie. No chronic lung disease here. How many shots would you need march & april? I am not sure if I would pay for them out of pocket. They are really really expensive. Part of me feels like if you can swing it for one or two shots do it, b/c if you don't & he gets it you will be mad at yourself. You can check on the cdc website rsv trends in your area, if that makes a difference in your debate. Good luck!
thanks...Right now we would get him 1 shot which would get him to the end of March. I looked on the Synagis website last night & there is a hotline for those who do not get approved. I'm calling it in a few & see if they can help.
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| Posted 2/16/11 8:33 AM |
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