31 for 21 - DAY 4!!!

FRUSTRATION

I. Just. Want. To. Scream....  Today's post will not be a positive one - it will be full of negativity and frustration.  All because of medical insurance.

Colin's doctor sent in a request for him to be eligible for the RSV vaccine this year.  It is given every month, for 6 months - November through April.  On average, it's around $2000 per injection.  That's a lot of money.  Today my insurance called me and said that it is not "medically necessary" for Colin to receive it.  Really?  Not medically necessary huh?  Well, I'm glad they feel that can make that judgement call when they don't even KNOW my son!!  If my son's doctor felt that it wasn't medically necessary would she have sent the paperwork in?  I don't think so.  In his short year of life he has already had multiple colds (that linger for WEEKS!  Not days like a "typical" child), 2 rounds of bronchiolitis and one round of RSV/pneumonia.  Twice we have been in the ER for support because his breathing was so bad.  One of these ER visits led to Colin being sent up to Univ. of Chicago - Comer Children's Hospital where he stayed for 13 days.  But they're right, it's not medically necessary.

I was told by ALL the dr's that saw Colin through his LONG hospital stay that children with DS are more prone to RSV.  It can also hit them HARD and FAST.  I can tell you from experience, that when Colin had RSV he went down hill in literally less than an hour.  But oh, they're right, it's not medically necessary for him.

I politely informed the lady on the phone (I know, she's JUST the messenger - she didn't make the decision) that I was glad that Anthem felt like it wasn't medically necessary.  Because if he lands in the hospital like he did last time, it will be necessary for them to cover the bill - which last year topped $100,00.00.  She apologized, she understood - it wasn't her call.

But as a mother, it is absolutely terrifying to me.  I can't imagine EVER having to go through that again.  Breathing is natural, it's supposed to be easy.  But when your baby has his lungs and passageways covered with secretions, it's not easy to breathe.  Watching them struggle to breathe is scary.  All because they don't want to pay.  Because it's not medically necessary.

Because I know that I am Colin's biggest advocate I will fight - we will appeal and see where we get.  I have to fight for my son.  That's my job, because it is necessary.

Sooooo....  To end on a happier note, here are a few pictures of him today after therapy.  He was having a battle with the penguin.  I'm still not too sure who won.

Tomorrow will be more positive, I promise.  I was going to post tonight about Colin's therapy session today.  That'll be tomorrow.  :-)