We got a call from Punkinhead's pulmonary specialist today that has us fairly concerned. As most of our friends and family know, Punkinhead was born about 9 weeks early and because of that has to get a monthly shot for RSV. We and all other families that have our same health"care" company and go to the same pulmonary specialist have been denied coverage for this shot for the month of March. The doctor's office tells us this happens from time to time and not to be worried because they negotiate the coverage back, but they've canceled her Thursday appointment and let me know that she has to have her next shot rescheduled no later than March 13 or we have to quarantine ourselves. The other option is to pay out of pocket and then negotiate for reimbursement from our stupid health"care" company. Yeah, right, we'd never see that money again.
A lot of you have asked questions about this RSV thing, so I thought I'd put something up to explain it for those interested. Don't feel obligated to read it, it's kinda boring medical stuff, but please everyone, just say a prayer that the awesome folks at her doctor's office can negotiate quickly and easily and we can get her next shot ASAP!
I’ve borrowed a lot of the information in this blog with gratitude from another blog mommy facing some of the same challenges.
For those of you unfamiliar with RSV (Respiratory Syncytial Virus) let me do my best to explain. Like the flu or common cold, RSV is a seasonal virus. It starts in October and continues through April. It's common and easily spread infecting nearly all children by the age of 2.
Most kids (born at full-term) develop moderate - severe cold like symptoms, but due to preemies fragile, less developed lungs and lower immune system they are at increased risk for developing severe RSV infection leading to severe lung infection (ie: pneumonia), life-threatening breathing problems, hospitalization, etc.
The common complicating risk factors include: Premature birth (35 wks or less),
Low Birth weight (less than 5.5 lbs), Heart disease, Lung Issues, Being Around Other Children, Family History of Asthma, Exposure to tobacco smoke, Multiple Births
Punkinhead had the first two risk factors, but luckily none of the others apply and we can control her exposure to other kids. A lot of people have a hard to getting their insurance to cover the treatment (a shot of Synagis once a month), but because Punkinhead was born before 32 gestational weeks weighing 2 lbs 14 oz, up till now we didn't have issues being approved for it.
Synagis is the only approved medicine to protect from the severity of RSV, which is the #1 cause of hospitalization in babies under one year. However, if we paid for the shots on our own it would cost us about $1000 dollars per month for a grand total of over $8,000! It so expensive because it is actually NOT a vaccine, it’s the an antibody injection. A vaccine is a small amount of a dead virus that your body reacts to by developing antibodies to it and then it is prepped to fight the live virus when you encounter it. There is not a working vaccine for RSV so Punkinhead is given a ready-to-fight antibody that requires a “booster” dose every month. The first dose was only one shot, but once she was over 15 lbs, it’s a LONG needle in each leg every time to give her the right dosage.
Our health"care" company's purpose in cancelling ALL our pulmonary specialist's patients for the month appears to be an attempt to rid themselves of a few patients. They cancel us all, make us beg for it back, make us worry about our kids, and then make some money by cancelling coverage for a couple of kids whose risk factor is on the borderline at the end of RSV season. It's sick and makes me want to move to Canada.