Since my last post (Ages ago, I know. Holidays, family in town, celebrations, what can I say? You know how it goes.), anyway, since my last post, many the astute reader has asked, “are you paying for synagis?” What a good question! And a well-informed question as well, since it implies a knowledge that synagis is expensive.
For my non-medical peeps, synagis is a specific antibody, against respiratory syncytial virus (aka RSV), that is given as a shot. Aaaah, RSV, the archnemesis of the pediatrician during the winter, often arriving with its compatriot, the flu, causing ER censuses to double or more for months, filling hospital beds with infants on oxygen, during bad seasons sending otherwise healthy infants to the PICU. Synagis is given as a monthly shot at the onset of RSV season (typically October). Since it is not actually a vaccine, where lasting immunity is built in response to an antigen exposure, the shot is only effective while the recombinant antibody is circulating – typically one month. Therefore, the shot has to be given monthly through RSV season, 5 months or so.
So as I was crafting this post, I thought to myself, “I wonder if the average, non-medical person knows how much synagis costs?” So I turned to my resident average non-medical person, Erik, and inquired of him, “how much do you think synagis costs?” Now to say that Erik has the medical knowledge of the average non-medical person is probably underestimating him. I like to think that his marriage to me has at least allowed his medical knowledge to increase to slightly above average. At very least he would understand me if I told him I had a champagne tap at work and he knows that most pediatric ailments can be cured with Tylenol, Motrin, and most importantly, time. I’d like to say that my marriage to him has similarly increased my technology skills, but in fact I am afraid I still dwell at “below average” on that one.
Okay, so I ask Erik how much he thinks synagis costs. “Well,” he says, “I know you’ve said it’s very expensive, so I’m going to say … $200 per shot?” Aha, I’m thinking, this is good, he is actually a full order of magnitude off. So synagis costs approximately $2000 per shot. It’s hard to put an exact figure on the cost since it is dosed by weight, but $1500-$2500 per shot would be a reasonable range.
Even if I couldn’t anticipate your next question Erik would have revealed it, as he looked at me in shock and said, “What! That’s crazy! Our tax dollars are paying for that? What is this shot for anyway? Is it really necessary? If one of our bio kids needed that, there’s no way I would pay $10K for it!” (LOL, glad someone in the family confronts modern medicine with healthy skepticism.) So, RSV, like any viral respiratory illness, can masquerade as a common cold, but don’t let its benign act fool you – its effects in infants can be quite severe, sometimes downright scary. Hypoxic infants with RSV fill pediatric hospitals during the winter season. And while the full term infant with RSV who needs a little oxygen and some help feeding is so common place that it is considered the bread and butter of pediatric inpatient care training, that same infant with extreme prematurity or cyanotic heart disease likely provokes tachycardia in even the most seasoned of medical staff. The effects of RSV can be devastating in premature and otherwise at risk infants. It’s not uncommon for the treatment course in that situation to involve a PICU visit, intubation, a prolonged hospital course and lingering side effects on those susceptible lungs. Perhaps, someday, we’ll defeat and cage this villain with a simple vaccine, as medicine has done previously and triumphantly over smallpox, polio, Hib, pneumococcus, etc. Then I’ll be the senior ED provider who can speak the lore of “back in the day” when the ED was filled with sick infants with RSV …, just as some of my colleagues can talk with seniority about diagnosing meningitis “all the time” in the 80’s (prior to the development of Hib and prevnar vaccines). But until an effective vaccine is developed, our only option is the insanely costly synagis course. In case you’re wondering, there are strict algorithms to determine which infants qualify for synagis. They typically include premature infants (degree of prematurity and age at onset of RSV season taken into account), significant congenital heart disease and chronic lung disease. And yes, $10K sounds high, but it’s a steal compared to paying for a PICU admission.
So, all of that brings me to a topic that I have wanted to address for a long time – benefits. Whether you are considering fostering, know people who are fostering, would never consider fostering, etc. I feel that everyone should be equipped with an understanding of the support the government provides to help enable families to foster. At very least, it may come up for you at some time as a conversation point when a friend says, “we’ve been thinking about adoption.”
Until we started looking into foster care we had NO idea that foster children come with incredible benefits. So let me tell you the benefits our kids have. If I had infinite amounts of time to write, I’d love to do an analysis of how this varies state to state, but – infinite time to write – who am I kidding? At least this will give you an idea of what benefits Texas foster children have. To start, they have Medicaid. So, Medicaid pays for synagis, and everything else for that matter. Baby boy has had multiple doctors visits, therapist evaluations, a couple of medications along the way, as well as his monthly synagis shot. I haven’t paid a cent, no copays, nothing. Nearly every year during open enrollment Erik and I methodically weigh different insurance plans as far as copays and deductibles and prescription coverage and incentives for routine health visits, etc. I have to say, it feels odd to experience a plan where I pay nothing for anything. Foster children are also eligible for WIC (similar to food stamps). As baby boy downs around $250 per month of Alimentum (special formula), the WIC benefit has been substantial for us, as it fully covers this and more. Incidentally, it is also the benefit that has caused me the most personal dilemma over whether or not I should take advantage of, since it is optional for foster families. Someday, I’ll write about my experiences as a WIC shopper. Foster children also come with a monthly stipend. Children without any significant medical or behavioral needs are considered a “basic” placement and the government pays the foster family $23.10 per day per child. Children with significant medical needs are considered “moderate” or “advanced” and the stipend is appropriately increased. If a foster parent who is single or both foster parents of a couple are working they are eligible for coverage of daycare costs. When a foster child is adopted many of their benefits continue. Depending on circumstances (age of child at adoption, adoption of a sibling group, etc.) foster children may be eligible for Medicaid and their monthly stipend until they turn 18. Children adopted through the state receive full tuition at a Texas college. Adoption fees are – WHOA, wait, what was that, did I just say that adopted children have full in-state college tuition covered? Yes, I did. That’s a big one. And, adoptions fees are covered by the state.
Of course this is not meant to be incentive alone to cause people to foster. Clearly, foster parents give much more of their hearts and time than could ever be fully compensated by benefits. But, the benefits do help remove some potential practical roadblocks that could dissuade families from fostering. Nonetheless, when money is involved, there will be someone looking to take advantage. I will always remember the first phone call I made researching foster agencies, this was years ago. The man on the phone at this particular foster agency implored to me repeatedly in the first several minutes of our conversation that individuals/couples considering fostering must make a minimum annual income to qualify. After repeatedly stressing this point upon me I tried to assuage his concern and assure him that we met the requirement. Apparently not satisfied, he continued on with his tirade about people fostering for the wrong reasons and wanting to make extra money, etc. We didn’t go with that agency. When I first called Pathways, the agency we are licensed through, my conversation with the recruitment director went something like this: After initial introductions, she said, “the first thing you need to know about fostering is that ALL children who are placed in foster care have been traumatized in some way.” Pause. Okay … you’ve got my attention. Go on, I’m listening.
I’ll leave it at that for the night. Someday I’ll elaborate fully on the sentiment that all foster children have been traumatized, as well as tell you what it’s like as a physician to be the patient at WIC, and take you on a journey with me to family court – in as much heart wrenching, tear-invoking, eye-opening detail as I can confidentially provide. Perhaps for some this post has made foster care seem more financially reasonable than you may have thought, hopefully for others you now at least know more than you did when you started reading this post – if not about foster care benefits, then perhaps, about RSV and synagis.
(baby boy laughing at “ride a little pony”)