Synagis Question

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Synagis Question

Postby marialynn242 » Thu Sep 23, 2010 03:18 pm

So as a preemie mom im sure everyone has heard of Synagis the RSV vaccine. Last year I had to fight my insurance becuase it was through the state and my Dr and I still arent sure how we were able to get it. WEll this year we have blue cross blue shield and Im wandering if they deny our claim for the vaccine how I can fight it and if anyone has had any expierence with this? Thanks!
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Re : Synagis Question

Postby amandaoasis » Thu Sep 23, 2010 03:36 pm

We have BCBS and had no problem with Synagis coverage.
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Re : Synagis Question

Postby 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!
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Re : Synagis Question

Postby 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.
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Re : Synagis Question

Postby 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!
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Re : Synagis Question

Postby 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!
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Re : Synagis Question

Postby ckthomas05 » Fri Sep 24, 2010 09:00 am

BCBS approved my daughter for the second season.
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Re : Synagis Question

Postby 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.
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Re : Synagis Question

Postby 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.
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Re : Synagis Question

Postby 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.
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