Tuesday, October 14, 2008

Too Healthy!?!

I'm incredibly frustrated today. I called Olivia's doctor's office regarding her upcoming Synagis shots. It seems that our insurance company doesn't want to approve them. Olivia has been deemed "too healthy!" Too healthy? Apparently there is such a thing. Olivia has been healthy because we've done everything that we possibly can to keep her that way. I didn't know that by keeping her healthy, we were failing to protect her. She was a 23-weeker!! I thought she would get them until age 2 without any problems. Our city was one of the hardest hit in the nation last year. There are already RSV cases immerging. My husband was able to work from home last winter. He can't do that this winter. Thank you, BCBS, for keeping my stress level well above average. It seems our hibernation is going to have to be just as strict as it was last year.

So, I called the insurance company. I don't normally have to turn on my "angry voice," but it's reserved for times such as these. I'm not good at being mean. . .although I tried very hard today. They are blaming my doctor's office for not getting a written request in sooner. I asked if there was anything that I needed to do to speed up the process and our insurance company said it all had to come from the doctor's office. Can anyone offer any advice? Please help.


Kerry said...

Sorry, no help to offer, but I did want to commiserate. I know you would still be very vigilant this winter keeping Olivia healthy, but knowing she was somewhat protected with the Synagis shot would make you feel so much better I'm sure. I hope somehow it works out and she gets the shots. Stupid insurance companies. I really don't think insurance companies should be for-profit. Then maybe they would look at the benefits that treatments, medicines, procedures, etc. can provide for the person and not just how much money the company can save if they deny them. But, I digress...

I hope your week is going well (besides the obvious stress of dealing with the insurance company). I will be thinking of Logan tomorrow (and Baby B of course). I went to that website and checked out the Memorial Wall. It was rather overwhelming.

Give Olivia a squeeze for me. I will talk to you soon!

Sarah said...

Here's a link that might help:


Also, our insurance company has refused Synagis for Emery beyond the age of 2, which he turns in December smack-dab in the middle of RSV season, even though he's O2 dependent. We're currently fighting this, but no one is promising us anything.

You will need to contact your doctor. They can appeal and write a letter of medical necessity.

I'll keep my fingers crossed for you. Also, if you can, go to preemieblogmoms and post or check the archivese. Someone actually has a copy of a letter of medical necessity that your doctor would only need fill in the blanks.

Hope this helps!

Sarah M. said...

Contact your doctor and have them write an appeal. I'm sorry. :(

Kellars Mommy said...

I wish I knew what to tell you, unfortunately this time last year Kellar was in the hospital w/rsv and pneumonia but he was "too healthy" to get the 2nd year of synagis. I was livid. I will say that once we were in the hospital and I called the dr's office and turned on my one teed off momma voice Kellar was approved before I ever hung up the phone, which sort of made me even madder especially since it seemed so simple yet my child had to get rsv before they would approve him. Good luck to you and keep on pushing them to approve them..

23 Weekers said...

Crazy! I need to call and make sure that Kinnick and Carver get the shot. Kinnick caught RSV last year with the shot on board. I also have BCBS.


Amanda said...

Hey- Crazy stuff! It seems they give shots out to everyone except those who REALLY need them! My friend, Jill, Carter and Addies mom, just found out today that Carter was approved for the shot, but Addie wasn't! Wha? Lets give one to one and not the other! Crazy stuff!!! I know its different because both my boys were full term, but they did both have RSV- Jacob when he was like, 13 mos.- but Nathan when he was only 5 months- its not fun, I would definately fight for it!! I'm like you, I have a hard time gettin my "mean face/voice" on- but when it comes to your baby, sometimes you have to do it!!! (I know you know that, Im just cheering you on) :) Hope your doing okay, I'll try and write you later tomorrow!

RyanAndrew2007 said...

I don't have any advice, but I know the frustration. We are dealing with the EXACT same thing. Ryan isn't getting the Synigis either. This scares me a little. I guess we'll have to be extra, super careful and have even more strict regulations and hibernation this winter. I sure do wish we could have that extra "safety-net" for one more winter. Ugh!


Anonymous said...

Hi Jodi,
CALL your doctors office and use your mean voice there. The referral ladies should have been on top of that! I worked at a pediatrician office for years and we always took care of that pre-authorization for our preemies. Good Luck!

angie c said...

I hate BCBS. We've had them for 3 yrs, and thru the pregnancy and arrival of hannah, and they've been such a pain to deal with. I've had to call on almost every claim since I got pregnant with hannah thru now with immunizations, b/c they processed something wrong almost everytime. UGH. Good luck jodi!