I'm so angry right now. Blue Cross just called to say they're rejecting the request to cover the shots to protect Cooper from RSV because of "gestational age...and just not enough risk factors". WTF!? Cooper was born at 35 weeks (which happens to be the age at which and younger when babies are eligible for these shots). I frickin hate insurance companies.
RSV is an airborne illness that is commonly present at daycare centers and other crowded places (like airports!). The insurance company knows Bob is a pilot and is exposed daily to all these things and then comes home to us. They know Cooper is a daycare baby. They know he's been hospitalized twice for respiratory distress AND pneumonia and that he's not even 5 months old yet!
The shots are monthly and cost $1000 per shot, for up to 6 months depending on how long the RSV season is in your area.
I'm so angry.
P.S. - apparently, he didn't have enough risk factors -- for example, because we (Bob and me) are non-smokers, we're getting penalized - but if we were smokers we would qualify! Maybe I should start smoking for the holiday season. WTF!!!!
4 comments:
Unreal & maddening.
Hey, Elliott Richard got those but our insurance wouldn't pay for them at first either. His ped at the time eventually had to take on the insurance company. When he explained that the shots were cheaper than the hospital bills would be, our insurance company caved. Maybe if your ped and the pulmonologist both argue on his behalf they'll cave. It's worth a shot anyway. (No pun intended.) Good luck!
How do they *truly* know if you smoke or not? Cant you just say you do? Otherwise, contact the insurance commissioner. I have a coworker that has had to go that route on a few occasions and has always won his case.
Idiots! A possible $6000 is not even part of a drop in their bucket, for crying out loud, especially compared to what it could cost if, God forbid, Cooper were to contract RSV. Blue Cross is a huge company. I know from my work on our teacher union exec council that there are grievance/protest procedures one can follow. Your policy should have something of this sort, too. Cooperate greed doesn't care to recognize there's a little guy involved here who has had pneumonia twice! Keep us posted, Julie. How did Cooper's appmt go today? Maybe this new specialist can help your cause?
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