Saturday, December 21, 2013

Insurance issues & growing munchkins

I spent an hour on the phone yesterday trying to sort out some problems we've been having with insurance to get the babies their RSV vaccine, called Synagis. RSV (respiratory syncytial virus) affects the lungs and for you or me would just present like a cold. But for preemies who were born with immature lungs it can be much worse, causing pneumonia and bronchitis.  Because our babies were born before 35 weeks and were less than three months old at the start of RSV season, they should be receiving the vaccine, but getting it has been a royal pain in the arse!!  They got their first dose at their six week check up because the doctor just pulled it from her stash, hoping that by the time they needed their second dose (this week) we'd have it from insurance. Well that didn't happen so now we have to make another appointment just to go in for vaccines.

Our Synagis troubles started with our Aetna insurance, name changes, and a PSU process issue.  First they were having trouble with the switch from Baby Girl B to Avery, etc so it didn't look like the kiddos were covered. Then we had a problem because PSU hadn't submitted the babies enrollment forms to Aetna, so again it seemed like the babies had no insurance.  We finally got that sorted out, after Michelle made a bunch of phone calls, but then there was the matter of the copay.  The pediatrician warned us that we could have a pretty hefty copayment (think she mentioned ~ $500) so she told us we needed to apply for medical assistance for the babies so we wouldn't have to pay that. (Because the babies were premature they qualify for MA regardless of income status.) So we did that and got their cards in the mail and it is a good thing because our copay was $1300 PER KIDDO!!! Only problem was that the Aetna specialty pharmacy wasn't a preferred pharmacy for the MA plan the kiddos were automatically enrolled in!  So once they enrollment in MA was complete, everything got sent to another pharmacy. Well that pharmacy submitted the paperwork and was told that the Synagis wouldn't be covered by MA (for some reason that makes no sense...something about it being a medical not a pharmacy benefit?!?).  We got a confusing voicemail from Dr. Brink's nurse telling us to call this patient copay assistance group.  I did that today and it said you could apply online so I started that process only to find that social security number was a required question and we don't have theirs yet!  So I called back to apply over the phone and got to spend a fun 40+ minutes on the phone completing three applications! The good news is they were approved so we won't have to pay the $1300 copay!  (This time at least. I'm guessing next month's vaccine will involve another big process like this! Oh yeah I didn't mention that the RSV vaccine is a monthly thing throughout the winter!) 

So anyway, we're hopeful that this month's dose will make it to the pediatrician's office next week and we'll get the next round of vaccines either Friday or Monday.  The annoying thing is that things will change again next month because the kiddos' MA plan will be different as of January first. When you first sign up, They auto-enroll you in one of their HMO style plans, and then allow you to choose the plan you want at the start of the new year. Fingers crossed that we made a good choice and the approval process is simpler next time!!!

Speaking of pediatrician visits, the kiddos all got weighed on Tuesday and all are trekking right up their little preemie growth curves. They haven't shot up to get into the "real baby" growth curves (as Dr. Brink calls the normal/regular ones).  They're still below the 5th percentile on those charts as you can see from our app. 

Here are their weights as of Tuesday, one day before turning 11 weeks:
Isaiah: 8lbs 12oz
Ellie: 8lbs 3oz
Avery: 7lbs 15oz

By now I'm confident that we have three eight pound babies! That would explain why they're outgrowing a lot of the newborn clothes, but the 0-3 month clothes are still pretty big on them!! At the same time, it's kind of fun to be moving on to a new batch of clothes! 

In other health news, Isaiah and Ellie continue to struggle a bit with reflux and are taking Zantac to help with that. We weren't sure if the Zantac was helping so the doctor said we could stop. But stopping for a day was enough to let us know that it is helping! Avery got her first cold last week and passed it on to Ellie.  But overall they've been pretty healthy so far and we're thankful for that!
Tummy time
Showing off her head control

1 comment:

  1. Agghhh... preemie issues. The joys of insurance, synagis and reflux. We (thankfully) didn't have a huge issue with our insurance when getting approved but I've heard other horror stories from parents. We do however have the horror stories about Nana and her reflux. :)


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