IVIG and Blue Cross/Blue Shield

[PANDASmcnuggetsw/fry/coke]

Has anyone had any succesful coverage with BC/BS? Does anyone know their guidelines for coverage~ if any?

 

Thanks,

PANDAS McNuggets w/fry/coke

[kmom]

I get so confused with the ins. companies. We have Capitol Blue Cross and getting first IVIg next week for both kids and it's covered. When Dr. B's nurse called to confirm it was approved, I asked if they covered the 2nd one in 8 wks if needed. She asked the office manager and she said they don't require pre-approval, it's just covered. I get nervous it's too good to be true and worry I'll get a big fat bill afterward that's all mine but we'll just "wait and watch" about that since "waiting and watching" the kids not get significantly better from multiple antibiotics and motrin was an issue. Our ins. co. just needed to see immuno deficiencies from the lab results. I remember the nurses saying they NEED "pre" and "post" results. We tested in June and were labeled "immuno deficient" and again in Sept. With those results Dr. B. said 85-90% of the time his patients are covered. I hope that's your case too! Good luck!

[PANDASmcnuggetsw/fry/coke]

Blue Cross/Blue Shield is saying maybe....that does not tell me anything though! Thanks and best wishes!

[saidie10]

BCBS of Texas did cover our sons IVIG in August. The hospital caseworker assigned to getting the benefit information really fought hard for us. The letter from the doctor did say dx PANDAS and discussed it as being an Autoimmune Disorder, all of the labwork was sent and data about IVIG and PANDAS. We really did not think they would cover it! They also sent the IVIG bulletin from United Healthcare too. Well good luck! I know this is so hard!!!!

[PANDASmcnuggetsw/fry/coke]

Saidie and everybody,

Thank you so much for your input! Every bit helps. :-)

[tpotter]

Good luck. As most of you know, our journey has been a horrendous experience. They just agreed to start the whole appeals process over again, because I got proof that they had never listened to us in the first place (and my boys do have immune deficiency.) I think BCBS can be very mixed.