The babies had a 7-month checkup today. All went very well. Charlotte weighs in at 16 lbs, 3 ozs., and Gavin tips the scales at 17 lbs, 5 ozs. Our pediatricians and the NICU neonatologists have recommended that the twins receive the RSV vaccine this winter. Since they were born more than 2 months early and their immune systems are still developing, a case of RSV could do some serious damage. They would each need one shot once a month for 6 months, November - April, which is considered RSV season.
Except that our insurance company doesn't agree. Apparently, it was decided that the babies don't really need the shot. (Which begs the question: If 31-weekers don't need the shot, who does?)
They turned down our pediatrician's request to have the twins vaccinated, which means we would have to pay out-of-pocket for the vaccine. How much does an RSV vaccine cost, you ask? Somewhere around $1000 per shot. And remember, they need 6 shots. Per baby. Are you doing the math, people? That's $12,000 in shots.
Which means, unless the insurance company has a change of heart (let's all have a chuckle at that one), the babies will not be vaccinated against RSV this winter. Which means they will not be leaving our house this winter. We will be stockpiling food, water, and Purell, boarding up the doors and windows, and hunkering down for the winter. We'll send out an occasional digital photo just so you can see how we are faring. See you all in May!
That really really sucks about the insurance companies.
ReplyDeleteoh my heck Amy! does the insurance company not see what the cost difference is between the shots versus one of the babies being in the hospital with this?
ReplyDeleteCason had this once, very minor compared to the baby he got it from. I don't know understand the reasoning behind some of their decisions sometimes. I hope it works out and remember you will know what is best for YOUR babies.
Because I am good with the business letter, I would crank one out to the insurance company post-haste. There's usually an address given on the claim rejection, saying where you can write to have the claim reconsidered.
ReplyDeleteInsurance companies are basically in the business of NOT paying out money, so sometimes they reject things automatically without considering them, and don't really look at things until they're resubmitted--like customer service departments that first send a form letter and say, "If this doesn't answer your question, here's the REAL email address to write to."
If your pediatrician wants it, and the kids were preemies, this is the kind of thing the insurance should give some THOUGHT.
Thanks, Swistle, for the good ideas. I'm on it!
ReplyDeleteThat's insane! (says the girl whose insurance company will not pay for her hubby's tonsilectomy because it was not medically necessary)
ReplyDeleteI'm with Swistle, fire them off a letter. My son had RSV when he was 3 months old and we still see the effects--any time he's sick it goes right to his lungs.
RSV- according to the AAP (American Academy of Pediatrics) it sure sounds as if your babies would qualify for Synagis shots this season. Check out the information on http://preemiecare.org/ related to this and if you have any questions or problems just give us a call. Good luck and please keep us posted.
ReplyDeleteMaureen
Amy,
ReplyDeleteI'm sure that, Joel Ario, the acting Insurance Commissioner for the Common Wealth of PA would love to investigate why your insurance company would want to deny your premature twins their RVS shots.
I think you can find him at www.ins.state.pa.us
Good Luck!
Dawn