Thursday, November 17, 2005

RSV Vaccine

The cardiologist said that he thought that the synergis was a good idea and he would submit his approval. That is he did, but then he opened Jack's file and remembered that Jack was not a premie. Apparently, Jack doesn't fit into the requirements for Synergis (the RSV vaccine) because he was not premature and he doesn't have something like congestive heart failure. Actually, his heart has not had any problems since he's been out of the NICU. Being on the heart meds is not enough. And he's never had respiratory issues. So we're back to where we were.

I've tried to find out the cost, and as far as I can tell it would be $1300-1500 if he was a premie, possibly more since he's not, just for one month's protection against RSV. That's all I need really.

To the insurance company I want to say this...

We can decide right now that our son should be put on the surgery schedule for December. He would be admitted in December and have the surgery and spend a week in the hospital. During that week it is more likely than not that he will get RSV. When he does, without the vaccine, he will get very sick and he is already sick enough. The extra care required will cost far more than $1500. So really what I'm proposing is hedging the cost of the surgery. A financial deal with and extra benefit of additional customer satisfaction.

But, that's not how it works. They will want to save the $1500 by having me postpone the surgery. By postponing it, I will also be going into the new year which means new deductibles. So, while right now I've maxed out our out-of-pockets, next year they will start over and I will have to start paying all over again.

There is no common sense applied to this. They will have him wait to save the vaccine cost. They will have him wait so they can collect new patient deductibles from me. And the cost to this is not just my sanity, but they are risking whether something will happen with this stoma and he could end up getting the surgery anyway but on an emergency basis. That has to be more expensive than a planned surgery, plus he will then get the RSV from being in the emergency room and not getting the vaccine.

One track mind.

My inlaws are coming over tomorrow. I've got to get the house clean. Then I've got a school project I've got to get done because we're meeting with the client tomorrow. It's a financial project for a start-up. It's not too bad, except for the typical white male business student with attitude on my project. All his ideas are good and all of mine are bad. If this were the Apprentice, at this moment I would be doing my sidebar with the camera. Then I'd work to get him fired. But, since this is school and my grade is partially dependent on him, I'll try to make it work.


Blogger Boysmom11 said...

So glad you are back! Sorry you are going suffering this insurance crap - hope Jack hangs in there until you can convince them to let surgery proceed.

7:25 PM  
Anonymous Anonymous said...

My son was born premature almost 3 1/2 years ago, that was enough for our insurance to not fight about the Synergis. One thing I remember about it was the Ped's office saying it was a $2000 shot. And if the ins. company had refused or if we were uninsured the state/fed medicaid would have covered it. You may have some luck by trying your local Health Dept.

And although I have not written before, I was glad to see a post from you show up in my Bloglines. I wonder about all the people in the computer and how their lives are going.

8:22 PM  
Blogger Jen said...

Can you appeal to your insurance and explain the extenuating circumstances? (Maybe you've already tried that - I couldn't tell from your post if you'd talked to ins. or only your doctor.)

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Blogger Anna said...

There is no common sense when insurance companies are invloved. I'm so sorry this continues to be an uphill battle.

Good luck on your project with white male business student. If you're involved, I'm sure it will turn out okay! Have a good weekend: )

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Anonymous Anonymous said...

As a Mom to several with medical issues I KNOW just how helpful it is to exchange ideas and feelings with someone dealing with similar issues. You are computer-savy, so I very easily may be telling you something you already know, but if under Yahoo groups you type in your son's disorder several groups with parents come up. Hope this helps. Best wishes

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Anonymous Anonymous said...

You know, I seem to remember Julie of alittlepregnant writing about this - I know they had to use Synergis for Charlie and I vaguely remmeber info on this around the insurance question...Maybe she could help?
I'm glad you're back, just sorry that things are so hard.

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