Synagis Question

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Re : Synagis Question

Post by jayme » Thu Sep 30, 2010 10:02 am

I didn't know this about the second season- I wonder if the military is different. My daughter was born at 35 weeks and she got two years worth- which surprised us to begin with since she was not that early...

I also just got notice in the mail about the twins for their second season... although I'd assume that we'd be more likely to qualify since Ryan has a compromised immune system because of the cancer treatments.

Re : Synagis Question

Post by panguitch02 » Tue Sep 28, 2010 04:53 pm

Jameson only got the 2nd year approved because he had a low immune system and was under the care of a hemotologist at our children hospital. There is also a weird state involvment in CA with these shots (I think that is true with many states). Maybe the state requires insurance to pay if the child meets the states synagis qualifications. Plus the hemotologist couldn't fight for it, only the primary care physician was able to ask for approval. I would search your states synagis qualifications and see if you child meets them for a 2nd year.

Re : Synagis Question

Post by kdreher » Tue Sep 28, 2010 01:43 pm

I have FEP BCBS and my policy is good..Michael rec'd synagis from Dec 08 to April 09 but they would not approve a second year of synagis and most insurnance companies won't once the preemie is home and has grown and is into a 2nd season. Michael ended up having a supsected case of both H1N1 and RSV and was in the hospital for one night. The shot costs close to $1,000 per so if a child does not fall into the weight/age category as a preemie there may be a fight even for year one.

Re : Synagis Question

Post by bernadic » Sat Sep 25, 2010 08:30 am

We were able to get it for a second season because Luke was a 27 weeker and very small. However, I live in MI where the RSV season is a bit longer so that requires one or two more shots than people living in other areas. I had to fight with insurance for the last 2 shots. They gave us a one more shot approval so we delayed giving the shot a week and a half to try to expand it to the final RSV month. We had the ped and pulmonary doctor helping us too. Good luck.

Re : Synagis Question

Post by marialynn242 » Fri Sep 24, 2010 09:27 am

My Dr said she recommends it of course shes not that familiar with preemies because james is her first micro preemie but she always takes extra caution and if theres any problems(except for like common colds) she sends him straight to childrens hospital instead of trying to figure it out herself! So maybe shes just being extra cautious.

Re : Synagis Question

Post by ckthomas05 » Fri Sep 24, 2010 09:00 am

BCBS approved my daughter for the second season.

Re : Synagis Question

Post by kara » Thu Sep 23, 2010 05:42 pm

To add to my post, I think the way that it is viewed, is if there isn't a chronic lung issues, once a child is 12 months old, the chance of severe complications is low. They may get sick from it, but they are strong enough to fight it off, unlike an immune compromised 1 or 2 or 3 pounder. Additionally, almost all children get RSV by age 2. Some get a mild case, other's get downright sick for a week, and less commonly some have to be hospitalized for breathing treatments. It's a cold virus, essentially, but it can wreak havoc on immune compromised preemies and those with lung problems. I know I was extremely worried about not getting the second season of synagis, because I thought it was what kept DD from getting ill her first winter. Certainly it was important, but so was regular handwashing, sanitizing, and making smart choices about where I took her. She did just fine her second season, having only one or two colds. Synagis isn't a cure-all, and babies, especially those past 12 months are often crawling and getting into everything, so they can get into lots of other illnesses and viruses that synagis doesn't prevent, and that are equally as dangerous: flu, rotavirus, stomach bugs, colds, etc, as well as those same bugs which we can bring into the home.

Anyway, many of us have been there with the anxiety about the second winter. You aren't alone!

Re : Synagis Question

Post by julieb » Thu Sep 23, 2010 04:39 pm

We only got one season also. Our doctor told us they called and our insurance approved it but when they actually tried to order it, the insurance denied the claim. I hope you have better luck than we did!

Re : Synagis Question

Post by kara » Thu Sep 23, 2010 04:15 pm

Let us know how it goes. It's usually pretty tough to get a second season's worth of synagis unless there is a chronic lung disease. Even with a congenital heart defect we only got one season of it....and actually our pedi didn't recommend it.

Re : Synagis Question

Post by marialynn242 » Thu Sep 23, 2010 03:40 pm

Thats great news I just had my Dr call today and get pre approved so hopefully it goes smoothly!