RSV Shot

With RSV season coming up, I'm wondering if my twins are too big or too old to get the RSV shot? They were born at 35 weeks, DD weighed 5 lbs 6 oz and DS weighed 3 lbs 14 oz (with 9 and 13 days in the NICU respectively). They are over 4 months old now and both weigh 16 lbs. At their 4 month checkup, I asked the pedi about the RSV shot & he wasn't even sure if they were eligible for it or could get it at this point. I didn't push the issue then, but now I'm wondering if I should look into getting them the shot? I've heard it's expensive---does insurance usually cover it? I work full-time and the babies are in daycare, so I definitely worry about them getting exposed to all kinds of stuff this winter & want to protect them as much as possible.

 

I would call my insurance company and ask the criteria they require to pay for it. My guys got one shot while they were still in the NICU and that was all they got. They were born at 35 wks and it has been a long time ago but I think 35 weeks was right on the border of if they could have it and birth weights also played a roll. The shots cost around $1000 a pop is what I heard back then. I will tell you this, I had never even heard of RSV but we had the boys right at the start of the season and so the nurses really drilled us about it and to not take them in public until they were at least six months old or RSV season was over, which for us both happened at the same time. Anyway we didn't take them out anywhere and made it through the first winter. Winter #2 when they were 18 months old both them and little dd got RSV. We ended up with Lane in the PICU for over a week and he nearly died, Jack in the hospital for a week and Sarah in the ER and very sick with it all at the same time. It was one of the worst experiences of my life and I shudder to think if they had gotten it that first year. I can very well understand how it could take the life of a young baby. Use caution all you possibly can and if they can get the shots definetly get them.

Mary

 

We only got it the 1st year. My girls were born at 32 weeks at 3.8 & 3.14. They got RSV shots from Oct (birth) to April (6months). They weighed around 10/12 lbs at 6 mons.

They were no longer eligible after the 1st year. BUT would have been if they had had respitory problems or other serious issues. We did get RSV their 2nd year and one DD was hospitalized for 3 days....it was not fun.


I would look into your coverage. Ours was a cut off of 34 weeks & under 5 lbs & 9 months during RSV season. With additional qualifiers (respitory ailments, on oxygen, etc)

Does hurt to try to get covered and may be helpful- esp for your smallest baby since if theyget RSV weight can be lost quickly.


KC

 

You need to call your pedi to call your insurance company. You can see from my sig how small my girls were, but we were denied by the insurance company. Many require you to have a certain number of risk factors. Last year when I was trying to research this, I didn't get anywhere calling the insurance company directly. I had to have my pedi's office call them. GL.

 

Agree with Leighann. Have your Ped office call and see if they qualify. If they do, definitely get it. If they are big, then they get 2 shots at a time but I dont remember the one shot cut off. Our qualifications had to be daycare-no for us, smoking in the house-no for us, and 31 weeks or less gestation-barely. They were born at 31 weeks 6 days-we just made it. We had to go to the Pulmonologist for the shots. Our Ped did not carry them. Good luck.

 

We are still waiting to hear on approval from our pedi office. The shots are supposed to begin in October. I know that birth weight and gestation plays into whether or not they are eligible. Our girls were born at 29 weeks 2 days and were 2.8 and 2.10. We were told that they would qualify for it. The shots are very expensive so I think insurance companies are very choosy...

 

I think it totally depends on your insurance co and/or peds office. My girls were borm at 34 weeks and got the shots last year, almost no questions asked. I was wondering if they would get them again this year, but we just had thier 15mo WBV and the ped didn't mention it, so I'm not going to worry. They stay at home with me though, if they were in daycare I might push for it.

 

I think this is the standard criteria followed, but check with your insurance company. Mine missed the cutoff by 5 days, but it was still approved for them that first year.

http://www.dhhs.state.nc.us/DMA/Forms/SynagisCover.pdf

 

We were approved for them last year since they were born preemie during RSV season and were going to go to day care. This year though because of their weights and how well they have done, daycare was the only qualifying factor and it wasn't enough. I really wish we could have done them again this year but they are really expensive if insurance doesn't cover it.

Our pedi said that after a point it's cheaper for the insurance companies to pay for the one kid that gets sick to go to the hospital than for 50 kids to get the vaccine because it's so expensive. Nice, huh.

You definitely should get your pedi to submit the paperwork to at least ask for it though.