We officially found out that Humana, our insurance company, will not cover Synagis, the shot to help fight RSV, for the kids. :( There are guidelines Humana goes by in order to see if they qualify for coverage. Unfortunately, the kids do not fall into these guidelines. Humana looks at this as their second RSV season even though they were in the NICU for the last season. They got discharged in mid and late April which is the end of the season. They did receive one shot prior to discharge, but that does not do anything for them now. Our pediatrician feels that they should have the shots - that them being triplets as well as their low birth weight and being 30 weekers puts them at risk. She could appeal the decision but through her experience feels this would be a waste of time. We completely understand that because of our experience with the appeal process with trying to get my blood transfusions covered ended up with nothing to show for it. Humana is all about the money and not the well being of the babies (like they don't make enough money!!!). They have many hoops to jump through to get anything done, go figure.
So I am sure you are wondering how does this change things. It doesn't change anything. Our requests/plans are the same. The shot does not prevent RSV, just helps fight it. Tammy, the kid's nurse, explained to me what to watch out for regarding RSV. It starts as a regular cold but quickly turns bad. If that should happen we need to take them in to see the pediatrician immediately.
I would like to clear up any confusion that people have with what we are doing for RSV. YES, we still want visitors. All we are asking is that the people that want to come over please be healthy, if you have been sick please be symptom free for 7 days and to not come over even if you just have a scratchy throat or the sniffles. We prefer having only a few visitors over at the same time. Lastly, do not be offended that we ask you to wash your hands and use sanitizer even if you don't plan on touching the kids and to take your shoes and coat off. I hope this helps.
One last thing, I have found some websites regarding RSV. So help youself to the info if you would like.
www.marchofdimes.com/pnhec/298_9546.asp
http://www.rsvprotection.com/
www.preemiecare.org/rsv_resourceshtm.htm
www.eurekalert.org/pub_releases/2006-01/epr-nsi012906.php
www.nlm.nih.gov/medlineplus/ency/article/001564.htm
www.preemiecare.org/LungsTrees03-4.pdf
http://www.synagisinfo.com/
As always if you have any questions let us know.
Love, Jen
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