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12-19-2012 at 12:42 PM
meganole25
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Joined on 12-12-2007
Jacksonville, FL
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meganole25 is not online. Last active: 05-21-2013, 2:52 PMSilver

Another Synagis Question - How is it ordered

Backstory - we've switched insurance companies and are having issues getting it covered under new plan.

With previous insurance DS's pedi called CVS Caremark to order the drug. CVS then billed us for the deducible. With this the pedi had no part of the cost/liability.

New insurance wanted pedi to order the drug themselves then bill us. Thus the Pedi accrues the cost until they are paid by our insurance and/or us. 

Out Pedi refuses to work this way. They want nothing to do with the cost. I can understand why because it's such a huge cost, but frustrating because the insurance company has point blank told them it's covered.

So my question for you is how does your office handle things? Are you billed by the pharmacy or your pedi? I'm trying to see if the Pedi is being unreasonable. 

Again, TIA. 


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12-19-2012 at 12:46 PM
BostonKiss...
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BostonKisses2 is not online. Last active: 05-22-2013, 8:21 PMPlatinum

Our pedi takes responsibility for ordering the doses, and then the insurance company bills them.  Both of Judith's seasons were fully covered between both insurances, but if we would've owed anything our pedi would've billed us and we would've paid them.

I'd talk to your pedi again and see if you can get this worked out.  GL!

12-19-2012 at 12:49 PM
meganole25
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Joined on 12-12-2007
Jacksonville, FL
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meganole25 is not online. Last active: 05-21-2013, 2:52 PMSilver
BostonKisses2:

Our pedi takes responsibility for ordering the doses, and then the insurance company bills them.  Both of Judith's seasons were fully covered between both insurances, but if we would've owed anything our pedi would've billed us and we would've paid them.

I'd talk to your pedi again and see if you can get this worked out.  GL!

Thank you for the quick response. 


Love 09.23.00 | Marriage 07.19.08
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12-19-2012 at 1:37 PM
Usm123
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Usm123 is not online. Last active: 05-22-2013, 4:04 PMBronze
Our pedi won't order the shot. We go to an outpatient clinic through the hospital. I get the impression this is common from talking to the NICU social worker and dr.

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12-19-2012 at 1:49 PM
missgoosey...
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Joined on 07-15-2012
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missgooseyface is not online. Last active: 04-16-2013, 1:12 PMNewbie
our pedi orders it and handles all the paperwork etc.  Thankfully, we got approval for 5 shots covered 100% but I am sure if there was something owed, the pedi would bill us...just as with anything else (co-pay, etc).  I would have another conversation with the pedi (or maybe the office manager/nurse in charge because they probably know more about this kind of thing than the Dr).  Good luck!

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12-19-2012 at 1:56 PM
Sahara78
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Sahara78 is not online. Last active: 05-22-2013, 5:17 PMNewbie
I had to double-check my claims, but it looks like my insurance was billed by Briova Rx, a specialty pharmacy. The Synagis dose was ordered and administered by my pedi's office. My insurance changes Jan. 1, while DD's next Synagis is scheduled for Jan. 2. I haven't gotten approval yet either. So stressful; I hope you get things worked out!

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12-19-2012 at 3:33 PM
Pips09
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Pips09 is not online. Last active: 05-22-2013, 8:00 PMBronze
Ours was also handled through our Pedi's office. I'm sorry you are having trouble with them. You certainly don't need something else to worry about!

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12-19-2012 at 5:42 PM
rslhmg
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Joined on 09-25-2012
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rslhmg is not online. Last active: 05-19-2013, 12:31 PMNewbie
Dds shot is done by an in home nurse, she did the ordering for the shot, I'm just not sure if she's through the pedi or not because when our pedi pushed for DD to be approved and get it in home they weren't clear if she was through them or just a nurse they refer to for in home visits.

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