At last

Punkinhead got her Synagis shot yesterday, but not without one last major obstacle. I'll start at where the saga left off though.

Buzzkill had read on The Consumerist that our insurance company had a department called Consumer Advocate that works outside the normal channels of approval and can work quickly too. He called the number and explained the entire situation, got a call back 10 minutes later that we'd been approved, and by Monday morning had a letter confirming all the details for our doctor. Yeah!

We faxed the letter to our doctor so we can get our appointment scheduled for Monday afternoon and here's where the last hurdle occurred. The only technician trained to give Synagis is ON VACATION for the week! They can't give her an injection until next Monday!!!!! I mean, the whole point of why we fought so hard was to get her shot in a specific time frame and if we wait until next week, I have to quarantine through March anyway.

HotMommy has a small breakdown and called Buzzkill, who in a wonderful, manly, take-charge manner (this manner is only welcome when I'm emotionally overwhelmed) says he's going to take care of everything and not to worry. He called the company that makes Synagis and found out which doctors they supply had the medicine on hand and then started making phone calls to see who could give her an appointment Monday afternoon.

Once he got Punkinhead's appointment (4 p.m. second to last of the day), he came home from work early, drove us over, and was there for emotional support during the appointment. HotMommy has one special hubby!

Thanks to all for supporting us during this crisis. I'm so glad it's over and Punkinhead is safe and protected.

News from the front

It appears the Synagis situation is going to go our way, but we won't have confirmation until Monday, so I don't want to go into the whole story yet.

Just keep up the prayers and positive focus for us 'cause it's working!

Liar, liar and not the funny Jim Carrey kind

The insurance company doctor that denied Punkinhead's March Synagis shot gave his reason for denial as "treatment not consistent with published medical evidence."

It's a TOTAL lie. Our state officially extended the RSV season here on March 8th because of..........VIROLOGY SUPPORTED HIGH LEVELS OF RSV!!!!!!!!! And the state published that info too.

All of Punkinhead's doctors say a March course of Synagis is needed and we even know that the health"care" company is approving shots for other babies all over the state so clearly they know it's needed. This is getting ridiculous.

Our last hope is that Buzzkill's company complaining that they paid for Punkinhead to be covered and that they're losing money with all the hours Buzzkill has to spend on the phone trying to get this fixed will get the insurance company to approve her shot.

HotMommy has been crying some hot tears of frustration today.

I'll go all 15 rounds if that's what it takes.

The latest on the Syngais saga....

Apparently, I've misunderstood the cost of this shot. It's about $1,100 a DOSE not a shot and Punkinhead is now getting THREE doses based on her weight. If we pay out of pocket that's $3,300!!!!!!

So lets add up what the cost would have been if we'd had to pay for all her doses October-February. $11,000

We were referred to a group that is run by the Synagis makers that helps people get the medicines their doctors tell them they need when the insurance companies say no. This group can really help put pressure on the insurance company and has helped our doctors billing office realize that the insurance coordinator won't return their calls because if they stall long enough, it will be too late for her shot to be effective and they won't have to pay. They gave them advice on how to get around the local representative that's stone-walling. Buzzkill and I also got some helpful tips. We went to Buzzkill's benefits person at work and explained what's happening so she can put pressure on the insurance company. Buzzkill's employeer is the insurance company's "real client" and they're much more worried about the company's business than they are about our individual complaints.

We've also been told by this helpful group that despite what the insurance company's local rep has told the doctor, our insurance company is paying for Synagis injections for March ALL OVER the state because our RSV season is longer!

HotMommy is determined this health"care" company is going to pay what they're supposed to! (Rocky theme plays in the background of my mind)

Keep those positive thoughts and purposeful prayers coming. They're greatly appreciated......

Shot update

We're officially denied coverage for her March shot.

It looks like the CDC is saying for April no one needs a shot because this RSV season is ending early. Since we don't have to worry about coverage for an April shot, we're going to bite the bullet and pay for March.

We could quarantine on principle, but then I might go insane before the end of March, and really it's about what the Punkinhead needs more than anything.

She should get it tomorrow. Health"care" sucks. Pardon my language.