<p>Upping our coverage to the next tier is something we hadn’t thought of and is well worth exploring. Thanks for that!</p>
<p>OP,
Do I understand that you are getting conflicting messages from you r dr. and insurance about whether it would be covered? Can the doc write a letter of medical necessity? The insurance may not cover it if they think it’s for cosmetic reasons, but if the doctor is concerned that your S may truly not grow much more (and the insurance co. may want proof of curent height, projected, etc.), than that may be the impetus to get this covered.</p>
<p>I have had to argue plenty of times with insurance companies about medical coverage and testing – my oral chemo costs $50K/yr. and I have to take it every day or else. It usually takes going up a couple of levels to get a person who’s authorized to authorize, and sometimes it means getting the doc involved, but it is usually possible.</p>
<p>Ultimately, getting the meds covered is a better solution than going broke, keeping D out of school, or negotiating with the college for FA (who may “help” by giving you more loans). </p>
<p>This stinks. Good luck – I’m sure you can find a way to make this work.</p>
<p>Been thru this scenario with 2 children of friends. Make sure you take S to a MAJOR hospital with pediatric endocrinologist. A doctor there will know what tests to order to ascertain the cause of the failure to grow. Brain scans will help determine if there are signs of a tumor or some defiency in the pituitary gland. The blood tests can take 5 hours!</p>
<p>Once you get test results, and a definitive diagnosis, then you begin the argument with insurance company. Your MD’s report and supporting phone calls will help.</p>
<p>In the long run, proving the merits of your S’s needs to the insurance company will be more productive than altering FA (tho of course, that’s worthwhile in the immediate).</p>
<p>Don’t tell Amy she looks child-like–she’ll kick your butt.</p>
<p><a href=“http://tlc.discovery.com/fansites/lpbw/bios/amy.html[/url]”>http://tlc.discovery.com/fansites/lpbw/bios/amy.html</a></p>
<p>Bookworm is correct–your child will need to meet specific criteria re: hormone testing, growth data etc in order for an insurance company to cover this treatment and certification of this need will need to come from a pediatric endocrinologist. Also read your policy carefully even if your son meets criteria, GH may not be a covered benefit under your policy—if that is the case, no clinician can write anything that will convince your insurance company to cover the GH. This is often not known by folks, that your particular policy will exclude certain treatments like growth hormone, organ transplants etc</p>
<p>If that is the case, I would recommend contacting HR at your work (if your policy is work based) and ask them if they will consider altering your specific policy to cover this extra-ordinary need</p>
<p>I know everyone’s health coverage is different, but I succeeded in getting growth hormone covered under our health insurance policy for one of our children. I had to take 2 appeals, but I did finally succeed. The doctor and his staff (at the local children’s hospital) were very helpful in knowing what kind of tests and documentation were necessary. Also, the drug company gave us the medication for free during the year it took to fight with the insurance company. Several different companies make HGH, so if one company turns you down, you could apply to others. The drug company that was so generous with us was Serono.<br>
The insurance company initially approved coverage for a year, but at the end of the year, the doctor documented the progress and argued that the child would benefit from another year of treatment, and the insurance company extended the coverage for another year. We ended up terminating treatment at some point during that year.<br>
Best of luck to you and your son.</p>
<p>Just to be clear, the diagnosis has been made through all the conventional testing, including a clonidine argenine pituitary challenge and a head MRI. The problem is the insurance policy covers growth hormone only for Turner’s syndrome. I love it that CC posters have suggested things we hadn’t yet thought of–like the higher tier of coverage possibly available at my husband’s employment. Because we are “excluded” rather than “denied” there is no appeal possible. But we are pursuing other ways of paying for it, including applying for the 1 year patient assistance program through the drug company. Thank you all for your suggestions and concern; I will keep you posted as to developments.</p>
<p>I’m 16 and 5’
I had the opportunity to take growth hormones around age 13, but chose not to. I don’t mind being short (most of the time).
But it’s socially acceptable for girls to be “petite.” All you need are some nice, comfy pumps and Voila! 3 inches right there. </p>
<p>I think it’s a bit different for guys.</p>
<p>^ go US!!!</p>
<p>3bm103 - I have heard that a lot…but what if I become bald when I am 30, then I will be short AND BALD:(:eek:</p>
<p>CONTINUE to pursue all avenues of covereage through your health insurance. Find out if the state you are in ALLOWS your ins company to exclude HGH coverage. Something seems odd here that “only” Turners syndrome is a treatable condition. I would put in an inquiry with your states’s insurance commissioners office. In our state, they are patient advocates and help to explore coverage issues such as this. It’s a call, some paperwork. They can examine the policy and coverage. To be honest, just knowing that an investigation is opening on a HGH exclusion issue can cause a company to reexamine their excluding your son.</p>
<p>Aiko - My 19 year old daughter is 5’0 tall. No one ever mistakes her for being a younger child. It is all in the way you carry yourself and in your conversational skills. Time to learn to deal. Use your height to your advantage. My daughter loves her height and so do guys (of all heights)!</p>
<p>Wellspring- I have a 13 year old son in the same boat as yours. He is also severely growth hormone deficient (scored a 2 on the stim test last April!) and is now on Humatrope injections every night. Every month I have to pay by credit card $3358.79 to the pharmacy or they will not deliver my son’s medication. Our insurance does cover it now at 100% (after our $5000 deductible plus copay was met last month) but we have to lay out the money and then they send us reimbursement a month or two later. This medication costs about 40k a year! There are resources out there to get your insurance company to cover this medication. They will fight the companies for you. Here is a link to the page of the Humatrope website that deals with reimbursement:</p>
<p><a href=“http://humatrope.com/common_pages/reimbursement.jsp?reqNavId=2.2.5[/url]”>http://humatrope.com/common_pages/reimbursement.jsp?reqNavId=2.2.5</a></p>
<p>My second daughter, now 17 and 5"1, was on Humatrope for 4 years because a chronic medical illness was stunting her growth completely. The people at Humatrope got our insurance company to cover the medication for her (they had previously denied our claims).
There are people out there that can help you. Good luck and let me know if I can help in any way (since this is my second time around with this one).</p>
<p>yeah guys like my height too :D</p>
<p>It seems outrageous for an insurance company to limit HGH to Turner’s. I can understand them trying to get around borderline cases (like a 10), but true medical conditions are not right.</p>
<p>I think everyone on CC who has been thru this has not found it easy. Lots of paperwork, phone calls from doctors, the various manufactures (serono, genotrope, etc, patient advocate, and possibly a lawyer. </p>
<p>I have to change insurance, and have several contracts. I will peruse to see if they put limitations on HGH.</p>
<p>our best…</p>