I just found out our boys qualify for synagis again this season, but because we just switched insurance we'll have to meet our deductible again...which is $2,000 per boy. Our boys are big enough and will get a big enough dose that their first shot will likely take up the deductible, so we'll have a $4,000 bill in November! After that, they'll pay 80%, so we'll still have to continue paying 20% up to our $5,500 out of pocket max for each boy. I just switched to a smaller employer so our group benefits aren't as good as what I was used to, so these are kind of shocking numbers! I have to confirm, but I think these are calendar year totals....so the January shots will result in yet another $4,000 bill, then the 20% co-insurance up to $5,500 each...again! We're not rolling in money but we can find a way to make this work if we need to. So my question is, what would you do? Is it worth finding a way to pay for the Synagis or not? I'd love any input you can provide. Thanks!
Gosh, that's a hard one. I have been saying that if the boys qualified for them this year (we did them last season) we would do it. But they dont. But that is alot of money that you have to lay out that could go to other things that they need. Ours were given by the Pulmonologist and when I called this year they based it on age and whether there have been any health issues especially lung issues. Have you talked to the Dr. about the predicament?? If the Dr. really thinks they would benefit I guess I would find a way to justify the cost. But that is just me!!
Can you sign up for a Flexible Spending Account for medical expenses thru your job? You put pre-tax money into an account to spend of these sorts of things. But you would only be able to spend it on the shots after the new year. At least that will save you a little bit. I would talk to your doctor or their office insurance biller about it too. Its a lot of money, but if they need it, they need it. Our insurance company originally gave us preauthorization and then decided that our girls are 'too old' to qualify. Thankfully we pulled them from daycare and they will be home with us this winter or else I would be a lot more concerned. Good luck figuring it all out, Leighann
We don't have a flexible spending account option at my new employer....with only 6 employees I'm lucky we have the benefits we do. I think I will call the doctor and discuss this further, but a big part of me says that if they even qualify, that tells me that we need to find a way to do it. They haven't had any health issues, not even a cold, which actually makes me more worried because I don't know how their immune systems will handle something when they do catch it (of course maybe they're so good that they've just fought everything off before we even saw the symptoms). They are also big now, 21 pounds each at 9 months actual age. But they were born at 30 weeks, so I'm sure that's why they qualify...they were born early enough that they're still considered at risk. I guess the bottom line is that I would probably literally die if these guys ended up in life-threatening danger because of a serious RSV infection after we had decided not to pay for the shots. Priorities, KWIM?! (But yeah, a year of in-state tuition for college could be covered by the cost of these shots....so it's still a tough one for me) I'd still love more input. Thanks!
We were having the same debate at our house. Our insurance coverage is exactly like yours. But our girls ended up not qualifying this time around, so that ended the debate. It's a hard decision. Good luck!
QUOTE(BridgePort @ Oct 23 2007, 08:43 PM) [snapback]463974[/snapback] I guess the bottom line is that I would probably literally die if these guys ended up in life-threatening danger because of a serious RSV infection after we had decided not to pay for the shots. Priorities, KWIM?! (But yeah, a year of in-state tuition for college could be covered by the cost of these shots....so it's still a tough one for me) I'd still love more input. Thanks! Totally agree! I think that way with everything when it comes to my kids. The whole "what if" theory.
You would be so mad at your self if you opted not to pay for them. Will your insurance pay for "all" of it if it is considered a "must do" thing, not a choice"? Good luck! jena
QUOTE(jena4 @ Oct 23 2007, 05:14 PM) [snapback]464097[/snapback] You would be so mad at your self if you opted not to pay for them. Will your insurance pay for "all" of it if it is considered a "must do" thing, not a choice"? Good luck! jena I don't think it matters. We have to meet our deductible no matter what. Which is another good point actually. If these guys get RSV and end up needing to be hospitalized, then we'll have to pay the deductible for that! No more debate...we're getting the shots! DH and I discussed last night all the totally unnecessary things we spend money on. If we can justify those things, we're certainly not going to skimp when it comes to our boys' health!
