Howlands vs. Insurance Company

After over a month long battle with our insurance company we got approval for the boys RSV shots, FINALLY!!! They originally denied coverage of their shots because they said they were “too old”. I think they were hoping that we would just accept it for what it was and not challenge them, but they were wrong. They obviously don’t know how persistent Bryan and I can be when we feel strongly about something.
I got fed up enough that I called the nurse whose name was on the denial letter myself. I don’t think she realized she was speaking with someone who has a medical background at first. She kept rambling on about how the boys didn’t meet all of the criteria and I politely explained to her that I didn’t really care about their criteria, the shots had been ordered by three different doctors who have a pretty good idea of whether or not they are necessary and if they denied them they were going against three different doctors orders. And to make a long story short we both got off the phone pretty frustrated with each other and I was told my statements were going against 5 different physicians, who made up this criteria, expertise.
I have to say that if Bryan and I didn’t feel that the boys needed these shots we would not have pushed the issue because they are very expensive and we will pay a decent chunk of money for our co-pay for these shots. We feel so strongly about this that we are willing to put forth the money in the best interest of the boys.
I then called our pediatricians nurse and explained my conversation with the insurance company to her and she agreed that the boys should have qualified for the shots regardless of their age because they were diagnosed with Respiratory Distress Syndrome when they were born and Kaden has what they call Chronic Lung (which after reading their list of qualification should have automatically got him qualified) which means that his lungs would be more sensitive to illness and he would not tolerate a respiratory illness as well as a full-term baby and could have lasting effects as a result of a major illness like RSV.
After many phone calls and help from the pediatrician’s office, who had to resend all of the boys documents, from the time they were born to now, to our insurance. The insurance company called on Wednesday and told us we had been APPROVED for 5 doses each baby!!!
For those who are not familiar with the Synagis shots, they are administered once a month for several months during RSV season. This year RSV season started in December so the boys missed out on the first round but the season usually lasts through March or April so they will be covered for the rest of the RSV season. We will have to take the boys to the pediatrician’s office every month for their shots until RSV season is over.
I am not looking forward to the extra pokes for the boys but we can rest assure that we have done everything in our power to keep them healthy.

More Christmas Photos

Braylon wrapping his brother

Kaden

Braylon

Braylon

Kaden

Christmas Village Display

Bryan and Brenda started the collection when he was little and now we are continuing the tradition


Handmade Toy Boxes From Grammie M and Papa Mike McDonald



Christmas Night at Locomotive Park