The insurance company denied the RSV shots for Baby Kevin based on new criteria they have established. From as early as I can remember, all the NICU staff stressed the importance of the RSV shots. We got sent home with packets of information about RSV. The pedi seconded the warnings and recommendations of the NICU nurses, doctors and neonatologists. However the insurance company decided that because Baby Kevin will be 6 months by November 1st that he is now magically strong enough to fight off RSV. I was shocked that they denied it! Even the personal nurse who works with Humana’s personal nurse service stressed the importance of the RSV shots until she found out about the denial. She then said well “they’re denying it because he is strong enough now”. Uhmm really? What changed since our last conversation?
Anyways the pediatric lung disease specialist agreed that Baby Kevin does need the shot. He said in previous years there would have been no question about Baby Kevin’s eligibility for the shot. He said insurance companies are suffering and trying to find ways to cut corners. He said it’s really sad that these insurance companies are willing to put babies at risk just to save some money.
In case you are wondering, the shots are about $3,000 each. He would need around 5 shots administered once a month so it is a very expensive treatment. Well I am very hopeful because the pediatric lung specialist is going to aggressively appeal the denial. We have an appointment scheduled for October 30th. We are praying the denial is reversed by then. The doctor said his lungs/respiratory system simply cannot be put at risk right now. He is still dealing with issues of prematurity.
For some good news, Baby Kevin is continuing to put on weight! He weighed in at 15lbs 1oz (with clothes and a wet diaper) and he is 23 ½ inches tall. He definitely is becoming my little chunky boy! He was a very well behaved little boy for his appointment. He smiled and babbled with the nurse and doctor. They said boys normally don’t “talk” this much at his age. So yes he worked his charm with them.
Anyways please continue to pray for us as we live a hermit’s life. J Pray for God’s will and for protection from illnesses. I normally look forward to the holiday season. It’s my favorite time of the year! I am trying really hard to do that now. I am just so worried about his health and weakened immune system. It seems like people all around me are already beginning to get sick.
Well here are some pictures from today.
Wow, he's a chunker!! Kirk is nearly 7 months old and he only weighs 15 pounds. But then, I tend to have small babies. :)
ReplyDeleteDon't fret the shots. Just trust that God will either provide or He will keep Kevin safe through the RSV season. I'm really shocked by that price though! Why in the world does a preventative treatment cost that much?? That's just crazy! No wonder insurance companies are cutting back...I would have thought medical technology would have come further than that.
Thanks Emily. I really am trying to stay focused and hold on to the truth that God is in control. :)
ReplyDeletewow he weighs the same as Kirk? That is crazy because the nurse said that only puts him in the 10% for weight and height for his age? Oh well every baby is truly unique and different! He is a chunker in my book :)