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Old 11-08-2011, 08:08 PM   #1
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Ugh...its RSV season again but this year we arent allowed Synagis!

So my boys turned one October 4th. They were 27 weekers but faired well and 'graduated' from the Nicu without any severe issues. They did require oxygen for over a month so they technically have BPD/chronic lung disease but are not on oxygen or meds or followed by a pulmonologist. Apparently these are the reasons our insurance company is using to DENY OUR SYNAGIS pre-approval.

I'm soooooo ticked. My pedi appealed on our behalf to no avail. I'm contemplating appealing again on my own but am having trouble, even with all my grad school resources, finding what feels like adequate proof of need.

Has anyone else been able to get insurance approval for SYNAGIS during your second RSV season?

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Old 11-08-2011, 10:10 PM   #2
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Re: Ugh...its RSV season again but this year we arent allowed Synagis!

Wow! That's crazy! My 25 weeker had the injections for 2 years and she does not have any residual lung problems either. I would definitely do what you can to push for it.

I hope it works out for you
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Old 11-10-2011, 09:29 AM   #3
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My 32weeker got denied for her first year. She is almost 5 months old, has two older siblings plus I am an ER nurse so lots of potential germs. Our ped appealed but still a big no. First time I've ever had an issue with my insurance
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Old 11-12-2011, 12:48 PM   #4
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Re: Ugh...its RSV season again but this year we arent allowed Synagis!

Our 28 week triplets were denied the second year also; they have changed the requirements and it's much tighter now. However, I will say that the research supports the tighter standards. But I know it sucks
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