Was your Synagis / RSV covered under medical insurance, or separately under prescription drug coverage (with its separate, very high deductible)?

Asking for a friend with a 25 weeker.

Thanks!

BGG born 4/25/05 at 31w1d




New baby girl born 9/19/06

We live in Canada - it was all covered.

Janet
G - 12/07 35 weeks
GGG-04/10 30 weeks

Ours just got approved for a second season. It is covered by our Insurance. However, because a home health nurse comes out to administer it we have to pay 20% of that service. Apparently home health care is considered durable medical equipment. Still it is a great deal compared to what the shots would cost for kids who are 26 lbs.

Lisa T
bbg 30 weeks
5-8-10

Ours were covered, but we had to schlep all 3 babies to the pedi's office 1x/month to get them. I'm not even sure if we had a copay.

DS born 5/15/06 @40+ weeks 7 lbs 12.5 oz
BBB born 9/13/10 @ 31 weeks
3 lbs 4 oz (33 days in NICU)
3 lbs 3 oz (49 days in NICU)
3 lbs 4.3 oz (45 days in NICU)
http://doublethelanglais.blogspot.com

Medical insurance ... home visits from Children's Hospital nurse ... covered at 100% for two years.

Jessica
http://lilypie.com>

We had a different insurance company for each year, but both years it was covered under medical insurance.

First year, home health nurse would have been covered after we met our deductible ($2,000 per kid) so I took them to the doctor's office and had no co-pay.

Second year, home health nurse was covered completely.

Allison

Mom to:
Madeline 09/2001
Jack, Evan & ^Alex^ 03/02/2008 @ 26 weeks

Ours were paid for under insurance, but we had to get a letter of necessity from the doctor (the daughter who got it two winters has some lung problems, so her pulmonologist wrote the letter). We had a $50 copay.

Amy

Julia, ^Caitlin^ & Gabrielle



Visit us at http://onealaskanmom.wordpress.com

Our regular medical insurance covered Synagis for 5 mths, but our co-pay alone would have been about $1,000/mth until we reached our co-insurance limit of $3,000 for the year.

We approached the Patient Access Network (PAN) Foundation, a 501(c)3 non-profit org that helps the uninsured and under insured with co-payments. They covered 100% of the girls' Synagis co-payments.

Our GGGs qualified for a payment of $1,500 each (total of $4,500 for all 3). We only used $3k until we reached our co-insurance limit for the year.

The insurance billed the foundation directly for our co-pay. Your friend can complete the foundation's prescreening (telephonically or online). We filled out a straightforward 3-page form for each triplet, and our pediatrician filled out one page for each girl. The income requirements are listed on their web site. We qualified because I was on maternity leave at the time and not earning an income.

GGG born Oct. '09 at 32w6d
http://ginnegaap.blogspot.com

I actually just got off the phone with our insurance company about this after getting a letter that the pharmacy benefits were changing. It is under our pharmacy plan, although for whateve reason we still didn't have to pay anything last year or this year. Apparently though as of Jan 1st there will be an $80 charge. I guess it is still worth it in the grand scheme of things but free was still better!

I was surprised when we were even approved for the 2nd season, since even though two have chronic lung disease diagnoses, since they have been off O2 for a while (well over the 6 month time frame) they technically didn't even meet criteria.

Lara
Mom to GGG born at 25+4 on 12/25/2009

Medical Insurance, I only had to pay the doctor co-pay not the prescription co-pay which is way higher for me. We did get the shots in the pedi's office.

JILL MOM TO
KOURTNEY 3 LBS 1 OZ
KEEGAN 2 LBS 1 OZ
KARVER 1 LB 10 OZ
10/4/08 @ 29 weeks

My medical insurance paid for it. I had a high dedutible the first year. In my insurance plan all preventives were covered at 100% and that made the synagis covered at 100%. The second year we had medicaid which covered 100%.