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Insurance Change Could Increase Baby Virus Risk

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In this handout photo, an adult doctor places his hand by a premature baby. (credit: Getty Images/Loyola Univ. Medical Center)

In this handout photo, an adult doctor places his hand by a premature baby. (credit: Getty Images/Loyola Univ. Medical Center)

CBS DFW (con't)

Affordable Care Act Updates: CBSDFW.com/ACA

Health News & Information: CBSDFW.com/Health

FORT WORTH (CBSDFW.COM) – With it temperatures getting colder, we’re now in the heart of Respiratory Syncytial Virus (RSV) season.

The virus is potentially life threatening for premature babies and the health risks to the child just increased because many health insurance companies aren’t covering some of the medicine needed to fend off the illness.

At just three months old, twins Hallie and Leyla Northcutt are already facing an uphill battle. “Their lungs aren’t as developed and if they do get RSV, they’re more likely to be in the hospital,” explained their mother, Angie Northcutt.

The twin babies were born seven weeks premature, which makes them highly susceptible to RSV.

Dr. Gerald Nystrom heads up the neonatal intensive care unit at Texas Health Presbyterian Hospital in Dallas; the same ICU where Angie’s twin babies were kept after they were born.

“Respiratory Syncytial Virus is very important public and community health issue,” Dr. Nystrom insisted. “It’s the most common cause of hospitalization in infants in the first year of life.”

The medication Synagis is most common protection against RSV. Premature babies that are 35 weeks or younger typically receive the shot during their first year. The five shots are spread over the months of November through March.

After her twins received their first two shots, Angie learned her health insurance wouldn’t cover the remaining three doses. “It’s frustrating that the health insurance company gets to make the decision rather than my doctor,” she said.

Angie and other new parents of preemies are discovering the unpleasant change in coverage that was spearheaded in 2009 by the American Academy of Pediatrics (AAP).

The AAP determined that most premature babies, born between 32 and 35 weeks, only need two to three Synagis shots, instead of the full dosage of five.

Doctor Chris Straughn, a pediatrician at Medical City Dallas Hospital, isn’t so sure about the AAP determination. “Between 32 and 35 weeks, I think those babies are still at high risk and would benefit from Synagis,” the doctor said.

At nearly $1,500 a shot, Angie says the medication is too expensive to get the last three shots for each of her daughters. The North Texas mother isn’t alone, other parents are finding out that insurance isn’t covering all of the medication and are taking the risk of not getting their children the shots.

Most health insurance companies will cover all five Synagis shots for premature babies born at 32 weeks or less.

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