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01/29/2005
And they say there's no health care crisis in America
RSV — respiratory syncitial virus — is the most common respiratory virus in babies and young children. It's highly contagious; virtually all children get it before age 2. Most of the time, it causes an illness no more serious than the garden variety cold, but in premature babies, it can be life-threatening. 125,000 kids are hospitalized yearly with RSV, put on ventilators, returned to an ICU. And about 2500 infants die yearly from it.
There's no vaccine for RSV, but there is a drug that can keep the illness from becoming so severe if a baby contracts it. It's called Synagis, and it's given every 28 days during RSV season to babies who meet certain criteria — premature birth, chronic lung disease, or both.
It also costs the motherfucking earth.
The dose is calculated by weight, so the cost increases monthly. The total cost of Synagis during a single RSV season can exceed $6000 per child.
Charlie's first dose was administered in the hospital in Connecticut. His second was delivered to our house to be given by a visiting nurse. The dispensing pharmacy called a few days before shipping to let us know the package was on its way, and to alert us that our insurance company was agreeing to pay only 40% of the cost for the injection.
There must be some mistake, I thought. It's a prescription drug, just like any other, covered with a reasonable co-pay. Someone's made a mistake.
Ah, but after several phone calls we have determined that there was no mistake at all. Charlie's Synagis — a drug so effective that his doctor said, "I can't tell you how many lives it's saved" — is covered on the same schedule as drugs that enhance erection.
Imagine my delight.
It turns out that there's a bit of controversy surrounding Synagis. While it's been proven to be remarkably potent against RSV, it's not thought to be cost-effective as a prophylaxis.
Follow me? It is cheaper to hospitalize a kid when he's sick than it is to prevent the illness to begin with. So the insurance company's taking its chances. Taking its chances with my kid's health.
I know this is what insurance companies do. I know they're a business. I know each company must minimize its own risk to maximize its profit. And I think it's fucking unconscionable.
Look, we're lucky. I know that. No matter what, Charlie will get his shots. We can afford to make up the difference in cost. And even if we couldn't, we'd have to find a way. We're parents who love a child, a flesh and blood being, after all, not a corporation that answers only to its shareholders.
And to think I was miffed when the company wouldn't pay for fertility treatment.
Posted by Julie at 10:09 AM in Mama drama | Permalink
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Comments (87)
That's just wrong. You - or anybody else with a medically fragile child - shouldn't have to put yourself in debt to prevent something so potentially life-threatening!
I'm sorry you are having to deal with this Julie (and Paul). Your precious little man is worth his weight in gold, and I'm glad to hear that he is getting these much-needed shots.
Posted by: Woodys Girl at Jan 29, 2005 10:16:38 AM
the only way we could afford for the twins to get the Synagis was to get on medicaid for that year. it's abominable that a drug company would charge so much for the shot and that the insurance will only pay for a portion.....it equates to about 3,000 per kid per month..... :O
for one, we could have found a way to pay for it....for two....thank you unlce sam....not that i'm proud of it, but i'm thankful.....
Posted by: Stephanie at Jan 29, 2005 10:17:06 AM
There are few organzations that I hate any more than insurance companies!!! I am so sorry that they are playing games with babies lives. It's so f'ing wrong there are no words.
Posted by: Stephanie at Jan 29, 2005 10:18:53 AM
I FUCKING HATE INSURANCE COMPANIES SOMETIMES!!
That is LUDICROUS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Posted by: Liz at Jan 29, 2005 10:33:56 AM
The short-term thinking of insurance companies infuriates me. Ours refused to pay for IVF/PGD because their infertility protocol dictates that you have to go through three failed IUI's before you can start IVF. Never mind that my problem is recurrent miscarriage, and if I went through three IUI's, I'd probably end up with three more miscarriages and the related costs of D&C's, etc. So we just have to suck it up and pay out of pocket.
I'm glad your little guy is getting the medicine he needs, at least.
Posted by: Karen at Jan 29, 2005 10:42:49 AM
Makes me think the drug company charges so much for it because they know parents will pay because they fear for the health of their children.
There's something wrong when "cost effectiveness" is more important that a child's health. Not only that, but those that get RSV are more prone to asthma as children. Are you telling me it's cheaper to treat their symptoms instead of preventing the problem in the first place?
Sick.
Posted by: Amy at Jan 29, 2005 10:59:36 AM
Dickholes. That's repugnant.
Posted by: Jo at Jan 29, 2005 11:02:50 AM
I'm so glad Charlie is getting Synagis.
I am so very lucky that my ins. co. has picked up the entire tab for my son's Synagis injections, other than co-pay and deductible. I'm not sure we'd have been able to afford it otherwise.
Posted by: Nance at Jan 29, 2005 11:11:22 AM
Oh, that pisses me off to no end! My 30 weeker got Synagis shots, but they were 100% paid for by the insurance company.
I HATE the state of Ameican health coverage. This is coming from someone who found out that her friend's mother recently died from a preventable condition that she KNEW she had and was caught early enough to treat. She put off the expensive treatment, because she was waiting for insurance coverage - and she put it off too long and died.
The fact that insurance companies would rather play Russian roulette with babies lives than just cover a treatment they know will work. Ugh, that just makes me so mad!
Posted by: geeky at Jan 29, 2005 11:24:08 AM
My son was born in Aug 2000 and he had synagis shots for 2 years and I am still paying for the bill!! They are unbelieveably expensive. Plus towards the end since they go based on weight he had to have two shots every month. He despised the dr's office for about a year afterward. I have to keep telling myself that probably saved his life. He was 3 11 oz when he was born at 37 weeks.
Posted by: Megan at Jan 29, 2005 11:27:31 AM
That is just DISGUSTING! I feel sick. And I can't even say "I can't believe those fucking insurance companies" because, sadly, I CAN.
Posted by: Anna at Jan 29, 2005 11:39:34 AM
Been there, done that. Our insurance company flat out REFUSED to pay for ANY part of Brody's Synagis vaccine. (He was born 6 weeks early, spent 10 days on a ventilator with RDS, went home on oxygen.) Of course, they refused to pay for it AFTER he had been given the vaccine... said he wasn't high risk for RSV. We decided to continue the shots anyway- our pediatrician said to expect it to run about $1500 a month. For 3-4 more months.
My thought was... what is another $6000 to the insurance company, when they've already paid $267,000 for his NICU stay??
Posted by: Kate at Jan 29, 2005 11:44:05 AM
Insurance companies suck.
Both of my (twin) babies got RSV. Nothing worse than hearing a six month old hacking up a lung, or fighting every nebulizer treatment that is admistered to them.
Get this, my insurance covered everything from the time they contracted the virus. countless doctor visits, a nebulizer delivered to my home, and all the drugs associated with treating the illness. Funny isn't.
My babies were 38w. I was lucky they were strong enough not to be hospitalised. God forbid that they would have had to pay for that!
Hope Charlie is doing well. (and mommy too of course!)
Shinaidy
Posted by: Shinaidy at Jan 29, 2005 11:49:09 AM
Julie,
that just sucks that they only pay 40% - are you sure the ins. commpany knows that Charlie fits the criteria (preemie, born during flu season, etc.??) I'm sure you've already been through it all w/the ins. company a million times over, but I'm just floored that they won't pay it.
My twins were preemies born during flu season and while only one of my daughters fit the 'preemie' criteria (had to be 5 lbs or under I think?) the other one didn't....ins. still covered both since they were twin siblings. I took it a little for granted at the time, but I guess we were very lucky.
Sorry you have to shell out the extra $$$ but personally I think it's worth it - my girls had one minor cold each their first winter. Good luck :)
Posted by: shari at Jan 29, 2005 12:07:38 PM
Yepa, what Jo said. Insurance companies make my blood boil.
xxoo
Posted by: Anna H. at Jan 29, 2005 12:21:57 PM
Jo, I thought you said "duckholes" and that made me laugh but only after I was FOAMING AT THE MOUTH over the issue at hand. Sometimes I hate the way this country runs so much, I KNOW I'm giving myself heart disease. And then I stop and think about how living here with that is going to SUCK so then it just gets worse. But you know what? "Duckhole" is really, really funny.
Posted by: Nicole at Jan 29, 2005 12:31:00 PM
Unbelievable. Cheaper to have the baby in the hospital (risking more infection) than to cover the medication. Just plain wrong!
Posted by: Janice at Jan 29, 2005 12:31:15 PM
My oldest child spent three days is the hospital when she was 6 weeks old because of RSV. She wasn't even premature. It was scary, and there were babies around us much sicker with it.I had never even heard of the disease, let alone be warned about it. A vaccine would be wonderful.They should figure out a way to make this shot available to all infants. Only people worse than insurance companies are pharmacutical (I know thats misspelled, I am lazy).
Posted by: Lisa at Jan 29, 2005 12:41:43 PM
Let me get this straight: they choose to endanger an already fragile baby's life rather than ensure that the baby has the odds stacked in its favor from the get-go? to save a few bucks? (because this is very expensive for us, but for an insurance company? COME ON!).
That's just sick.
Posted by: Menita at Jan 29, 2005 12:49:09 PM
i feel so bad that you are still having proleams
Posted by: stephanie at Jan 29, 2005 1:15:56 PM
oh that is infuriating!! :(
Posted by: jenn at Jan 29, 2005 1:36:51 PM
You're damn right, Julie.
My twins were born very premature during cold season, and they're now on their second and final season of Synagis shots. They're doing great now, but at their current weights, the cost of their shots is over $6000 EACH MONTH.
Posted by: stephie at Jan 29, 2005 1:43:11 PM
heh. we lost our home because of my mom's medical bills (brain cancer). and that was -with- her own insurance coverage, and coverage under my dad's policy, too. i've got a looooongstnding grudge against the american health"care" system. glad y'all are able to stay afloat.
Posted by: wix at Jan 29, 2005 2:17:15 PM
I feel for you. I work for the bastards. Is there any sort of appeal level you can try? They almost ALWAYS have an appeal process.
Posted by: Jenn at Jan 29, 2005 2:26:32 PM
I wish that I could have given that to Emily - she was full-term and healthy, but got RSV at four months and spent a week in the hospital. It's some scary shit, and totally something that insurance should cover. Bastards.
Posted by: Shylah at Jan 29, 2005 2:39:18 PM
Yes, it is unreal.
Our insurance company did not want to pay for a repeat c-section for me when I delivered my daughter in March. I had had a primary c-section. I then had 2 v-bacs, but they were very stressful and both almost ended in an emergency c-section, with severe fetal distress, so with our 4th child, we decided to go with c-section (long, valid story). We live in a very small rural community, and the hospital is equally small and is not equipped to handle uterine rupture or a sick baby.
Get this, the insurance company was willing to take the chance that I would not rupture, and that the baby would not get in distress due to CPD. They wanted to gamble with mine and my babies lives. See, if I didn't rupture, and the baby did fine with the labor, they would not have to pay for anything, because I didn't have maternity coverage. They only cover complications of pregnancy.
My doctor was a champ, and wrote them a nasty letter, so they ended up covering it.
It is outrageous.
Glad Charlie will be protected this RSV season.
Jody
Posted by: Jody at Jan 29, 2005 2:58:43 PM
Damn. Unbelievable.
The good news, of course, is that Charlie's going to be protected.
Of course, if he has an erection lasting more than 4 hours, see your pediatrician.
;-)
Posted by: Karen at Jan 29, 2005 3:06:25 PM
The saddest thing about this is that you are actually lucky because Charlie is a preemie. With heart kids, like my daughter, there have been many fewer studies about the effectiveness of synagis. So since there isn't a study that *proves* its effectiveness in protecting children with heart conditions, many kids with CHD aren't getting this shot at all, even though to them RSV is incredibly devastating.
But all I can say is that if anyone is outraged by this, there are things you can do. Get active! It's babies now, but it might be your health care costs later...
Posted by: Minni at Jan 29, 2005 3:07:50 PM
I'm so glad you are able to make sure he can get it.
Think of all the mothers in the country that can't. Who make too much money at crappy jobs to get Medicaire.
It's just fucking irresponsible to be the richest country in the world and not take care of our babies.
Posted by: Cecily at Jan 29, 2005 3:14:46 PM
I'll never understand such thinking. I'll bet you if the asshole making the decision was someone in a financial situation that wouldn't allow them to make up the difference in cost and it was HIS kid, it would be covered as a preventative measure NO QUESTION.
Posted by: Mandy at Jan 29, 2005 3:31:59 PM
Ugh. Long time lurker here. Have great ins., however, we had the same problem with RABIES shots when we'd had a bat flying around our house with access to my DD's room at night (she was 2 1/2 yrs).
We saw the thing upstairs near the attic (rather heard it first, and did the dive-under-the-covers while it flew over our heads thing for 20 minutes before we were brave enough to try to catch it) but it disappeared. We looked EVERYWHERE, systematically, room by room and in between, behind & under everything, so assumed it left through the same hole from whence it came, and called someone to come find & fix whatever hole into the house needed fixing.
4 days later we find a sickly looking dehydrated bat flying wildly around downstairs, near her room. As we wash dishes in the kitchen DD yells from the living room - "Ooooh, a butteryfly!" Huh? in February? Next she yells - "Yuck, a mouse!" as I stick my head out of the kitchen & it buzzes the top of my head.
Unfortunately, not being able to get close enough to it to catch it in the cat carrier (the same darn cat who has killed raccoons, poor yellow finches, many squinnies & squirrels and saved the garden from many rabbits, let the thing live in our house for four days!) we finally corralled it into a closed off room & let it find it's way out the open door (in cold February) a few hours later. So nothing to test. I have my first Panic attack. DD had a tendency to wake up, come upstairs & crawl into bed with us, so her door was always open at night, perfect opportunity. Not likely, but the thing WAS hungry & thirsty after 4 days stuck in our house.
As I said, we have excellent insurance BUT, we couldn't prove that she HAD been bitten. Now, if she'd been bitten by a dog, it would have been another story. Buttheads. Once you are determined to have rabies, you go buy a coffin. No chance of survival. This is not something play you wait and see with. But if you get the series of shots within a few days, you live, no contest!
And bat bites are undetectable, even right after they happen, and since a 2 1/2 year old cannot tell us if she was bitten... "But there have been no cases of rabies from bats in the past 30 years where you live,nor the right type of bats." Uh-huh. 2 years later, 2 people died from rabies from bat bites in our state. Buttheads.
I'm so glad you can fork over your portion of the RSV - Charlie is so worth it. I just feel for those who can't and still pay rent or feed their children and their children suffer. It's not right.
Posted by: mj at Jan 29, 2005 3:35:46 PM
There's a special place in hell for insurance companies. Glad that you're able to afford it, but I just think of all those who can't and it's sickening that people have to make the choice between the life of their child or survival.
Posted by: Emily at Jan 29, 2005 4:31:11 PM
fuckingmotherfuckerratbastardcocksucking cast-ironhearted insurance CREEPS. ahem. That wasn't nice!
Posted by: jilbur at Jan 29, 2005 4:59:56 PM
Delurking to say grrrr, that makes me so mad...
Anyone see last week's ER? It had to do with the stupid prescription drug industry. While we were watching, my girlfriend, who's from Puerto Rico, turned to me and said, "Wait a minute, isn't there something in the constitution about the right to LIFE? What if someone can't afford a prescription to save his or her life?" I know you can't be denied medical care if you show up at a public hospital (although without insurance it's really freaking expensive), but what about being denied necessary prescriptions? Do you have to wait until you're hospitalized for the illness?
Right now I'm fighting with my insurance company, trying to prove that two recent trips to the ER (urgent care) were really necessary. Both occurred outside of office hours, within the same week. One was a badly sprained ankle, the same one I've broken twice before -- I couldn't put any weight on it at all. The other was a really bad case of adult chicken pox, which had been misdiagnosed as an allergic reaction by my regular doc, who gave me steroids for it. (Great, chicken pox on STEROIDS!) The "rash" kept getting worse for a few days, and by the time it showed up in my throat, on a Sunday, I was a wee bit scared about not being able to BREATHE if it continued (still thinking it was an allergic reaction). Doesn't sound like an emergency to me...
Posted by: Miriam at Jan 29, 2005 8:26:02 PM
When it comes to healthcare I am a total socialist. It is immoral that people profit from illness and injury. How can anyone risk a child's life in the name of the free market? And insurance would have to be about the biggest misnomer out - rip-off would be more accurate.
Appalled on your behalf and wishing you, Paul and Charlie the best of health!
Posted by: JuliaOz at Jan 29, 2005 9:04:55 PM
Hey, at least your ins. co. recognizes your son. We have been working with our insurance co for months because they have dropped him from coverage. You can't imagine how frustrating it is to have to prove to those agents that your six year old really does exist.
Posted by: susan at Jan 29, 2005 9:52:29 PM
I know so many people being screwed in one way or another by their health insurance situation...my best friend's insurance tried to stick her with the bill for a Johns Hopkins biopsy of her brain tumor (which was a very weird type), on the grounds that she must have authorized it. Duh. Hello. She'd had brain surgery that day. She wasn't conscious, and wouldn't be for another 48 hours or so. Assholes. Why can't we, as a country, do better than this?
You say you can afford this...and I hope that you're able to do so without too much hardship, Julie. As though you didn't have enough stress right now.
All best,
S
Posted by: Shelley at Jan 29, 2005 10:08:45 PM
My twins were born at 31 weeks last year, and my insurance company paid the full cost of their Synagis shots last winter. Because they were born before 32 weeks, they automatically qualified for the shots this winter as well. I have Oxford, by the way. We are very lucky. When we were in the NICU last year, when my girls were a few weeks old, another set of twins arrived in the NICU. They'd been born at almost 33 weeks. You could see what a difference the almost two weeks more inside made. They were progressing much faster than my girls, and looked like they'd be going home soon. Then all of a sudden I saw their mother crying all the time, and the babies were isolated. They'd gotten RSV. They went from almost going home to being on ventilators. Boy was I more careful about washing my hands after that. They recovered and did okay, but it was really scary. Anyway, my pediatrician told me that that couple's insurance company would not pay any part of the cost of their Syangis this year, because they were born at 32+ weeks. My pediatrician wrote an appeal for them, but the insurance company denied the appeal. My pediatrician didn't know if they would pay for the shots themselves or not. In his years of pracice, he has only had one family pay for the shots out of pocket. I have a feeling this family probably did. Judging from the size of the rock on this woman's finger, they could afford it. And I'm sure after what they went through last winter, they would not take any chances.
I think it sucks that your insurance company is not paying full freight for Charlie's first winter. You should appeal.
Posted by: j at Jan 29, 2005 11:05:48 PM
Well, I have no idea what the scenario would be were you insured under the BC health plan... I'd like to think your child would get the preventive care he required, at no extra cost to you, but who knows.
There are plenty of problems with the single-payer system in Canada, but I still maintain that it is, at its core, morally superior to the U.S.'s for-profit business approach to health care.
I just hope with all my heart that Charlie stays healthy and continues to grow and thrive, needing little more than well-baby checks which, I assume, are completely covered by your insurance.
Posted by: mollie at Jan 30, 2005 12:48:35 AM
There's the insurance company trying to discourage excellent preventative treatment of a very real and serious illness because of profit, then there's the pharmaceutical company charging exorbitant amounts for this drug as they do for all drugs, all so that the stockholders will be happy with their returns.
Posted by: Pazel at Jan 30, 2005 12:50:19 AM
Unbelievable...this cements my opinion that insurance companies are staffed by Satan's minions. UGH
So glad to hear that you can cover the cost anyway.
Posted by: Kristin at Jan 30, 2005 11:08:58 AM
You need to appeal this. It might not/probably won't make a difference, but for the amount of money you're going to be out of pocket, a few hours collecting letters from your NICU doctors, your pediatrician, and the company who manufactures Synagis--it's worth a try.
Yes, MedImmune is always happy to help folks get them more money, because they're vicious bastards charging thousands of dollars for this medication. And before anyone starts in to defend drug companies--or am I confusing your readership with the academics Calder hangs with?--I very much doubt it's merely the dose manufacturing costs being reflected in the ginormous price. This is MedImmune making back their investment costs as quickly as possible, and pricing for willingness to pay: what parent of a preemie will forego the drug unless they're against the wall? What insurance company wants to be featured on the local news as a parent of a preemie holds up NICU photos, clutches their healthy child in its adorable Pooh bear sleeper, and announces in a loud voice that their insurance company would rather pay for hospitalization than let their BAYBEE get sick? MedImmune knows it's got everyone up against the wall.
Now, go ask those bastards to help you:
http://tinyurl.com/6l2au
Because you're going to want the shots next year, too.
Posted by: Jody at Jan 30, 2005 11:54:48 AM
I'm sorry you are having this issue with your insurance company but as someone who had a baby survive RSV I'm happy to hear there is a drug to keep it at bay. My son weighed over 9 lbs at birth and was healthy as could be until he caught a cold at 15 days. Within hours he turned gray and all of his veins collapsed. Fortunately his umbilicus hadn't healed all the way and they were able to get an arterial catheter in place quickly. He spent 5 days in the NICU during which time all I could do is watch and pump and hope. I also spent some time marveling at my Goliath to all the little Davids in there who weighed between 1 and 4 pounds but that is another story.
He survived but I also had the experience of the doctor putting his hand on my shoulder and saying, "Do you understand how close he came...." I didn't need him to finish the sentence.
I'm really happy Charlie is home and doing so well. Happy days to you and your family.
Posted by: 21stCenturyMom at Jan 30, 2005 1:48:41 PM
The price for that shot is absurd! If my son would not have been on medicaid I have NO idea what we would have done. Now he was denied the shot because medicare shortened the RSV season that they will give the shot. Can you believe that?! And guess what? He got RSV, but he is all better now. This has got me worried about what insurance to choose next year when I work. I don't want to have to struggle w/ paying those vaccines and the NICU if my baby is premature. INsurances truly do suck!
Posted by: Johanna at Jan 30, 2005 3:29:22 PM
My son was born at 33 weeks in November 2000. Thank God, no respiratory support after birth was required. Upon discharge we were told that he did not qualify for Synagis because he was >32 wks. at birth and didn't need a vent. Even if we were willing to pay out of pocket for the shots, we couldn't receive them. 9 days after discharge from NICU (26 day stay) he was back in the hospital with an RSV infection that, I believe, he contracted at his first Peds office visit. PICU stay for 3 days under the O2 hood. It was gutwrenching watching my son turn a dusky blue-red shade, then pink up, only to turn dusky again. What a nightmare! Thank God he was fine and is fine and has had no residual respiratory problems from the infection. Thank God your son is getting Synagis. Insurance companies should be shot.
Posted by: Andrea at Jan 30, 2005 3:39:08 PM
I am one of the home health nurses that gives babies synagis in their homes. I am so sorry that your insurnace is being an asshat! Even the free sooner care for children here in Oklahoma pays 100% of this drug. Sometimes, it is over presribed and ordered for babies who weren't premature and haven't had RSV - maybe they had a cold or something soon after they were bron. Maybe that's why insurance companies are cracking down. Not that that makes it OK at all. Babies like Charlie NEED this drug to stay healthy. Damn insurance people. I am very glad that you can afford this for your baby. But you shouldn't have to. Thats what insuarance is for.
Posted by: Ami at Jan 30, 2005 3:56:55 PM
Ok, I didn't read the other posts so maybe someone has covered this, but aren't most drugs much cheaper in Canada? And it's legal to buy from there. I know you live in the Northeast, so maybe it's worth a drive to get the prescription filled at a Canadian pharmacy? Not sure if this is feasible or possible.
I think it's much fairer for Charlie's drug to be covered than all of my IUIs and IVFs (I live in Massachusetts, which mandates full coverage for fertility treatments including IVF, in most cases). I was just trying to make a human. You're trying to save yours from needless suffering.
Posted by: Carol at Jan 30, 2005 4:30:59 PM
For-profit fuckers. Profiting at the expense of human decency, human suffering, and sometimes human life.
It's so appalling to know that potentially life-saving medicine for your son would be covered at the same rate as medication for hard-ons for guys.
You know, if these pharmaceutical companies weren't spending millions and millions and millions of dollars on the commercials for Cialis and Viagra, etc., I am forced to watch every night (and I'm no prude, but I really hate seeing a commercial describing "longer and better quality erections" while I'm caring for my 81 year old dad), they might not charge so much for life-saving medications.
ARRRGHHH!
Posted by: Maura in VA at Jan 30, 2005 6:40:25 PM
We moved during the last month of my pregnancy to my new state. My insurance didn't want to play along and basically told me I couldn't go to the doctor and if I went into labor, I would just have to go to the ER. No checkups, nothing.
It took weeks of negogiating, but we got the insurance changed.
I feel for you but I'm glad you'll be able to cover the costs if needed. Unfortunately, we wouldn't be able to and would just have to take our chances.
Posted by: Sarcastic Journalist at Jan 30, 2005 7:04:53 PM
When Hunter, our 3yo, started having seizures at 2 months old, our insurance ok'd the treatments, EEG's, MRI's, everything. It turns out they were caused by one of his vaccines, but we didn't find out untill he had been given the same one 3 times. I think it was MMR? Not sure. After all that was over, we got a letter saying that they refused to pay any of it, even from the first time. 29,000$ total, including Doc. bills, etc. We immediatly appealed, on the grounds that they first agreed. We could have gotten Medicaid if they wouldn't pay. After a year and a half of fighting, they finaly gave in and paid the bills. Then, when he was 2 1/2, he needed a circumcision due to bad infections. Same thing with them. They said it wasn't neccesary, and meanwhile my son was screaming in agony everytime he peed or even rubbed against his diaper. We still owe 7,000 for that, and plus, another 5,000$ that they won't pay for an operation to remove a cyst from his neck. Again, they said unnecesary. Uh, hello, it was IN HIS NECK... cutting off his breathing!!!! Total fuckheads. We are still fighting them on both issues. And as soon as this is settled, we are changing insurance companies. Julie, I am so glad that you can afford Charlie's shots, but sad that you have to pay for them. We were almost forced to choose between our son's penis rotting off or giving up our apartment and food. Don't let them push you around, and the best thing is to talk to as many people as you can. It gets exhausting, but it helps. Best of luck to you, Paul, and Charlie.
Posted by: Rachael at Jan 30, 2005 8:12:15 PM
