Preemies & RSV: Working with Insurance on Synagis Coverage

RSV Strikes Fear in the Hearts of Preemie Parents
For those of you working through your first RSV season, know that we totally get your fears. Handwashing, quizzing loved ones about illness and lockdown weren’t supposed to be on your to do list this year. Thankfully there is a drug on the market that should be available to you to help your child through the season – Synagis. Given every 30 days from around October to March/April, this injection provides your preemie with much-needed added protection. As you know by now, no parent, even a parent of a healthy full-term baby, cannot be 100% vigilant on protection. It takes every resource you have to do it.

More Information on RSV
For those of you wanting more information about RSV, our ally organization, Hand to Hold, has a great video:

Working with Insurance on Synagis Coverage – Even When it is Denied

1. Ask your child’s doctor to contact the insurance company and to speak to the Medical Director. This has worked for other parents and may work in your benefit as well.

2. Contact the Bureau of Insurance for your state and file a complaint (this group may be named differently in your state but should be housed under your state’s State Corporation Commission). This regulatory body for insurance in your state will then take your complaint and call the insurance company. Provide the person working your case with information regarding your child’s NICU stay and any illness history since discharge. Also a letter from your doctor would be helpful especially if your child was rejected and the doctor still thinks you should go ahead with Synagis and pay for it yourself.

3. Contact your legal aid society for your state and ask for help there. There were two lawsuits in Ohio that were won against Ohio Medicaid for this very issue. So whether it is your private insurer or state medicaid, there is still hope.

Have a question or looking for a resource? Struggling?
Contact us! You shouldn’t have to go this road alone.