Synagis

There is a special vaccine (Synagis) that Katie qualifies for due to her heart condition. This vaccine is to prevent her from getting an RSV infection. RSV infections are like sever colds that can turn into bronchitis or pneumonia in young children. Children with heart problems have a very hard time recovering from RSV and often have to be hospitalized. In addition, if she gets RSV her heart surgery would have to be postponed indefinitely because it could cause severe complications with the surgery.

Katie got her first Synagis shot before she left the hospital, then she has to get one a month, throughout the cold season, to keep her immunity up.

It was a ridiculous fight trying to get her second shot which was due on Dec 9th. Our pediatrician ordered the vaccine through our insurance, Aetna. Aetna authorized the vaccine but for some reason approved it under my name and birth date rather than Katie’s. The doctor believed the shot would be shipped on schedule and arrive any day because they had done all they needed to on their end.

On Dec 9th, I called Aetna and they had no clue what I was talking about, and said it had never been ordered. I decided to drive to Katie’s doctor’s office and sit in the waiting room until I could get someone to help me. I got the attention of the nurse coordinator who also called and got the same run around. This initiated an eleven day phone war to get the vaccine.

Aetna kept claiming different reasons for why the vaccine hadn’t shipped. First, they needed the prescription again. Then they couldn’t find the prescription. Then we had to get it reauthorized under Katie’s name. Then they claimed we have pharmacy insurance and that company needed to handle the vaccine. Then they claimed they needed the prescription, again, etc.

Every time I would call, I would be transferred to many different people, and then told the doctor needed to call. Then I would call the doctor, they would call Aetna and get a completely different story. In the end, the doctor’s office yelled, demanded to speak to a supervisor, and then called the supervisor every hour until the prescription was sent.

We finally got the vaccine on Dec 20, 11 days late.

According to the doctor it should ship automatically from now on, but they are going to start calling a week before the next one is due. Katie and I are now celebrities at the doctor’s office because all the nurses and staff heard about the ridiculous process. When we went in to receive the vaccine everyone wanted to meet Katie, and of course, thought she was awesome. I survived my first insurance battle…joy!