Re: Growth Hormone and Eligibility Question

[Guest guest]

Tonya is correct. If a medical doctor deems it medically necessary

for a child to have gh, then the insurance company will pay for it.

That does not mean it will be without some sort of conflict. For

example, when my husband changed jobs, we had new insurance and they

denied his gh which he had been taking since he was almost 3. They

said he was not showing good enough growth on it, so they did not

want to pay. Dr. H. convinced them that he needed it and they now

pay for everything - including the syringes and alcohol swabs!

Jodi Z

[Guest guest]

What you describe in terms of eligibility varies by country, and by

insurance plan.

Yes, many if not most insurance plans want to see that the child is

less than the 3rd percentile. However, there are several

exceptions to this.

1) RSS Diagnosis: Helps a lot.

2) Mid-parental target height. What is the child supposed to be at

for height percentile based on his mother and father. If a child

should be at the 75th percentile, and yet is at the 3rd

percentile.... and the child is RSS and even SGA, then it can get

covered.

Our daughter was the 3rd percentile (sometimes above, sometimes just

below) although her weight was, gosh, at least 2 std devs below. My

husband is 6'4 " , I am 5'4 " . 's midparental target was 5'7.5 "

or 75th percentile. Both CIGNA and AETNA have approved GH for

for 4 years now, without a GH stim test as well. This was

clearly a result of Dr. H's refusal to do a stim test because " RSS

kids have normal stim tests; but they are GH insufficient " and she

has a list of the studies. (We ended up doing a stim test without

showing it to insurance and was very high at 21. Her IGF-1

of course was low normal.)

I don't know if this helps at all. But if your son is at the 5th

percentile, but he is supposed to be at the 75-95th percentile, and

he has the RSS/SGA diagnosis, you are more likely to get covered.

Salem

>

> I'm under the assumption that in order for a child to be accepted

at

> the age of 2 for growth hormone treatment - they must meet the

> parameters of the growth requirements; i.e., < 2 SD (standard

> deviations) from the Mean or in otherwords - the 5th percentile.

>

> My 20 mos. RSS boy has just recently attained the 5th percentile

mark

> on his growth chart - although he is still way below the 3rd

> percentile in weight. Our Endo (whom we have great faith in) has

told

> us this entire year that we would wait until he is 2 before we

discuss

> the whole GH idea.

>

> Obviously, we want to be able to administer GH but are concerned he

> may not be " accepted " when the time comes. My husband and I aren't

> anxious about it - we are very happy he is growing as well as he

can

> at this point on his own - but, we would like the opportunity to

> enhance his growth and was wondering if anyone else here has

> information or had a similar situation. Does anyone know if

insurance

> covers GH? I know each state is different but hate to call our

> insurance until necessary.

>

> Thanks for your help.