Atiredmom

From personal experience, this approach fails. PA's don't take a lot of time to do and they protect you. Prior authorization is always preferable if you want insurance to cover. We have had all sorts of treatments covered that we submitted ahead of time and none that we submitted after the treatment for PANS. A friend of mine has been through the same with fertility treatments. Also $30k! Wow that's a lot of money. Google the cost of Rituximab. I know that the NP who treats in CA is not charging that much and Walgreens and CVS are not either. You can find out the cost per 100 mg of Rituximab on several websites. http://consumersunion.org/outrageous-health-costs/cancer-drug-markup/ That means when your insurance does get the bill, they will likely write off the cost that is above usual and customary and won't consider paying that amount even if they do cover the treatment. That number is usually right around the rates they contract to large pharmacies like Walgreens and CVS. No personal experience with this doctor but I did read some alarming comments regarding submitting insurance there in this article which is part of why I decided to seek care for my children at another office. http://www.bethesdamagazine.com/Bethesda-Magazine/January-February-2016/The-Mystery-of-PANDAS/

This is great. Backed up so well with references.