This past week Adeline's reflux showed it's face and has been horrible. She has always been a "spitter," but this week was rattled with crying out in pain, sleeping less than usual and the worse exorcist style, can't breathe during, spit up that I have ever witnessed. So on Thursday we had a visit with our AMAZING pediatrician. It was determined that it was time to start medications, seeing as her three sibs all needed them as well we weren't surprised. Ella was our first on reflux medications. She started on Zantac, then went to Prilosec ending with Prevacid. Zantac made her throw up non-stop, Prilosec made it so that she couldn't spit when she needed to, which lead to severe pain/crying and constipation. Prevacid was a wonder med for her and when it came time for the twins to be put on meds, we immediately went to Prevacid. Worked amazing for them as well. So this was an easy decision, put her on Prevacid......easy peasy right???? NOPE!!!
Our insurance in all of it's infinite wisdom decided that she didn't need Prevacid. Well they can't really "say" that, but what they did say is that unless we try Zatac (and after 14 days it fails), then Prilosec (again giving it 14 days to see if it will also fail) then they won't cover her Prevacid....Bring on the momma bear moment!
I don't even know WHERE to start with this. My doctor, along with my input, decided that based of family history it was best to start with Prevacid, but our insurance has the ability to refuse to cover a medication prescribed by our DOCTOR, if they feel we should try something else first. I was in shock. They don't know my daughter, they have never examined her or spoke to me about history of our family. Even with my doctor putting in a pre-certification request and explaining why Prevacid was needed they denied it. I can appeal, but that can take a month......
I called insurance basically pleading with them to cover her medications, but the gentlemen (I say this loosely) got rude and condescending with me explaining before I could even speak how he deals with "upset" people daily from 8-5 and that he knows I"m probably "upset," but to remember he has no say....it took a LOT of Grace friends to not tell him where to stick it. Even after requesting to talk to his superior I was told this wasn't an option and I could send in my concerns/complaints in writing.
After numerous calls and begging to get them to help, I was left with the following options:
1) Pay for the meds out of pocket (they are $200 a month and won't count then towards our deductible)
2) Try Zantac and pray it helps/doesn't hurt Addie the way it did Ella
3) Same as #2-only with the Prilosec
How does a parent decide what to do when this is the options given. We can't afford to pay out of pocket for months for her meds, yet I'm terrified to try the other two based of the severe reactions we dealt with with Ella.
After a lot of praying (and crying) and talking with Bill we decided to try the Zantac. With our doctor's support of stopping it immediately if Addie shows any negative reaction to the medication. This decision was made with a lot of thought, but as a momma I'm outraged that I had to even make this decision.
Needless to say I was a angry, emotional mess by the time Bill got home from work. So we loaded up and headed downtown to the Celtic Festival. It's a tradition for us to go, and it helped me step back from the terribly awful no good day and just enjoy some moments of fun with my amazing husband and baby girl (big kids are with Grandma!)
For now I'm praying Zantac helps and doesn't hurt, that we made the right decision, and that a letter sent to our insurance provider will make them rethink how they handled this case.
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