RSV Shot

[lemonstolemonade]

Our pedi's office is getting the insurance run-around for
pre-approval. They have submitted the orders to the company that
does the shots for them to attempt to get it pre-approved. If that
doesn't work, the CF clinic says that they will get involved. I'm
just glad that there are people out there who fight for us when
others fight against us.

 

[lemonstolemonade]

Our pedi's office is getting the insurance run-around for
pre-approval. They have submitted the orders to the company that
does the shots for them to attempt to get it pre-approved. If that
doesn't work, the CF clinic says that they will get involved. I'm
just glad that there are people out there who fight for us when
others fight against us.

 

[Jenica]

Our insurance company (Harvard Pilgrim) covered the shot for my daughter last year. My daughter is also asymptomatic, and after answering 19 or 20 questions with a "no" (the only "yes" was in response to a question about whether or not we had friends and family with fireplaces), I was shocked when the Synagis was approved right away.

The pediatrician just submitted this year's Synagis, and I'm waiting to see if we are approved this year as well. My daughter turned one beginning of September, and they recommend getting the shot for the first two years.

Keep in mind too that if the shots aren't approved, you can always appeal. Harvard Pilgrim (whom I LOVE, by the way!) assigned our family a personal care management nurse, and she mentioned to me yesterday that if we were not approved this year, to continue appealing and that she would work with me on it.

Best wishes on getting it approved!

 

[Jenica]

Our insurance company (Harvard Pilgrim) covered the shot for my daughter last year. My daughter is also asymptomatic, and after answering 19 or 20 questions with a "no" (the only "yes" was in response to a question about whether or not we had friends and family with fireplaces), I was shocked when the Synagis was approved right away.

The pediatrician just submitted this year's Synagis, and I'm waiting to see if we are approved this year as well. My daughter turned one beginning of September, and they recommend getting the shot for the first two years.

Keep in mind too that if the shots aren't approved, you can always appeal. Harvard Pilgrim (whom I LOVE, by the way!) assigned our family a personal care management nurse, and she mentioned to me yesterday that if we were not approved this year, to continue appealing and that she would work with me on it.

Best wishes on getting it approved!

 

[Jenica]

Our insurance company (Harvard Pilgrim) covered the shot for my daughter last year. My daughter is also asymptomatic, and after answering 19 or 20 questions with a "no" (the only "yes" was in response to a question about whether or not we had friends and family with fireplaces), I was shocked when the Synagis was approved right away.

The pediatrician just submitted this year's Synagis, and I'm waiting to see if we are approved this year as well. My daughter turned one beginning of September, and they recommend getting the shot for the first two years.

Keep in mind too that if the shots aren't approved, you can always appeal. Harvard Pilgrim (whom I LOVE, by the way!) assigned our family a personal care management nurse, and she mentioned to me yesterday that if we were not approved this year, to continue appealing and that she would work with me on it.

Best wishes on getting it approved!

 

[lemonstolemonade]

Pedi's office called. They can't get Cigna to cover the shot, but
our prescription insurance will cover it with a co-pay of $35-50
for a 3 month supply. We're going to talk tonight a bit to see if
the possible $50 is worth the hassle to argue with Cigna about it.
We'll have the prescription delivered to our pedi's office and go
there to have the shots. There's NO WAY I'm giving my child a shot.
I would if I HAD to, but the thought just hurts my heart.<br>
<br>
Thanks for all of the encouragement folks! I'll let you know what
we decide by this weekend.<br>

 

[lemonstolemonade]

Pedi's office called. They can't get Cigna to cover the shot, but
our prescription insurance will cover it with a co-pay of $35-50
for a 3 month supply. We're going to talk tonight a bit to see if
the possible $50 is worth the hassle to argue with Cigna about it.
We'll have the prescription delivered to our pedi's office and go
there to have the shots. There's NO WAY I'm giving my child a shot.
I would if I HAD to, but the thought just hurts my heart.<br>
<br>
Thanks for all of the encouragement folks! I'll let you know what
we decide by this weekend.<br>

 

[lemonstolemonade]

Pedi's office called. They can't get Cigna to cover the shot, but
our prescription insurance will cover it with a co-pay of $35-50
for a 3 month supply. We're going to talk tonight a bit to see if
the possible $50 is worth the hassle to argue with Cigna about it.
We'll have the prescription delivered to our pedi's office and go
there to have the shots. There's NO WAY I'm giving my child a shot.
I would if I HAD to, but the thought just hurts my heart.<br>
<br>
Thanks for all of the encouragement folks! I'll let you know what
we decide by this weekend.<br>

 

[Ratatosk]

Part of the problem when we were trying to get DS his shot, I'd thought about driving down to Minneapolis every month to get his shot at the CF Clinic; however, they don't normally carry the synnagis vaccine -- didn't have enough newborns to make it worth the cost, so we would've had to convince a clinic we didn't normally go to, to adminster the shots. Apparently clinics get a large bottle of the serum and pretty much have all the preemies and high risk patients come in around the same time. Plus BCBS wasn't going to cover it at all. Normally vaccines are covered, but this wasn't and it was going to cost us $3500 a month -- times 5. That's when DS's godfather the attorney stepped in....

 

[Ratatosk]

Part of the problem when we were trying to get DS his shot, I'd thought about driving down to Minneapolis every month to get his shot at the CF Clinic; however, they don't normally carry the synnagis vaccine -- didn't have enough newborns to make it worth the cost, so we would've had to convince a clinic we didn't normally go to, to adminster the shots. Apparently clinics get a large bottle of the serum and pretty much have all the preemies and high risk patients come in around the same time. Plus BCBS wasn't going to cover it at all. Normally vaccines are covered, but this wasn't and it was going to cost us $3500 a month -- times 5. That's when DS's godfather the attorney stepped in....

 

[Ratatosk]

Part of the problem when we were trying to get DS his shot, I'd thought about driving down to Minneapolis every month to get his shot at the CF Clinic; however, they don't normally carry the synnagis vaccine -- didn't have enough newborns to make it worth the cost, so we would've had to convince a clinic we didn't normally go to, to adminster the shots. Apparently clinics get a large bottle of the serum and pretty much have all the preemies and high risk patients come in around the same time. Plus BCBS wasn't going to cover it at all. Normally vaccines are covered, but this wasn't and it was going to cost us $3500 a month -- times 5. That's when DS's godfather the attorney stepped in....

 

[lemonstolemonade]

Ok, read something interesting off the Cigna web-site about
Synagis. Having a diagnosis of CF alone will not qualify a child to
have it. The child has to have active respiratory issues and/or be
premature. Cigna considers Synagis an "experimental
treatment" in children with CF; therefore, they will not cover
the shot at all. Period, end of discussion. I think we've beaten
that dead horse. <img src="i/expressions/face-icon-small-confused.gif" border="0"><br>
<br>
We are going the prescription insurance route and will travel to
our pediatrician once a month to get the shot. They normally don't
do the shots, but will do it for our infant. It pays to be buds
with your pedi. <img src="i/expressions/face-icon-small-happy.gif" border="0"><br>
<br>
So, long story longer, we'll start the shot in November and we'll
be able to move forward from there. I've found some at home stuff
to do to keep me occupied so I feel like I am doing something for
me. It will be nice to have the shot to protect her when we are out
at playgroup and other outings.<br>
<br>
Thanks for all of your support. I'll let you all know if there is
anything else that rears its ugly head.<br>
<br>
Anne<br>
<br>

 

[lemonstolemonade]

Ok, read something interesting off the Cigna web-site about
Synagis. Having a diagnosis of CF alone will not qualify a child to
have it. The child has to have active respiratory issues and/or be
premature. Cigna considers Synagis an "experimental
treatment" in children with CF; therefore, they will not cover
the shot at all. Period, end of discussion. I think we've beaten
that dead horse. <img src="i/expressions/face-icon-small-confused.gif" border="0"><br>
<br>
We are going the prescription insurance route and will travel to
our pediatrician once a month to get the shot. They normally don't
do the shots, but will do it for our infant. It pays to be buds
with your pedi. <img src="i/expressions/face-icon-small-happy.gif" border="0"><br>
<br>
So, long story longer, we'll start the shot in November and we'll
be able to move forward from there. I've found some at home stuff
to do to keep me occupied so I feel like I am doing something for
me. It will be nice to have the shot to protect her when we are out
at playgroup and other outings.<br>
<br>
Thanks for all of your support. I'll let you all know if there is
anything else that rears its ugly head.<br>
<br>
Anne<br>
<br>

 

[lemonstolemonade]

Ok, read something interesting off the Cigna web-site about
Synagis. Having a diagnosis of CF alone will not qualify a child to
have it. The child has to have active respiratory issues and/or be
premature. Cigna considers Synagis an "experimental
treatment" in children with CF; therefore, they will not cover
the shot at all. Period, end of discussion. I think we've beaten
that dead horse. <img src="i/expressions/face-icon-small-confused.gif" border="0"><br>
<br>
We are going the prescription insurance route and will travel to
our pediatrician once a month to get the shot. They normally don't
do the shots, but will do it for our infant. It pays to be buds
with your pedi. <img src="i/expressions/face-icon-small-happy.gif" border="0"><br>
<br>
So, long story longer, we'll start the shot in November and we'll
be able to move forward from there. I've found some at home stuff
to do to keep me occupied so I feel like I am doing something for
me. It will be nice to have the shot to protect her when we are out
at playgroup and other outings.<br>
<br>
Thanks for all of your support. I'll let you all know if there is
anything else that rears its ugly head.<br>
<br>
Anne<br>
<br>