Sad Day...

[browneyesmom]

Phasmid... I'm still reeling from our trip to see Dr. B and the related travel home, but I saw this while there and looked for it this morning to comment. I am too out of it to be clear on anyone's history other than my own DD11 right now, but wanted to let you know that we were able to get IVIG approved for her through Blue Cross of California. I don't know if this helps you, but hope it will assist in trying to help your child and that things are improving soon... LOVED your IVIG poem!!!

[mom md]

We did high dose IVIG at home without issues. The cost of doing it at the infusion ceneter was $15,000 and the cost at home was $6700 including supplies and nursing care. I looked into all options because I was ready to pay out of pocket. (This was our third infusion and BCBS denied us after PEX and two IVIGs which all had worked). The difference was the hospital "facility" fee. We did give pre-treatment oral steroids and a 5 day taper, benadryl, pepcid, and an extra bag of 500cc of fluid post-tx. We had no isues. After we were denied I had all our treating docs write letters and then had one personally call the medical director of BCBS. She said all denial came across her desk and she had never recieved any medical records or letters on our child. That was BS. The info was sent multiple times. Finally a phone call and refaxing everything got us approvad. It was exhausting.

All insurance plans are not equal. Even within a company like Cigna. We now have Cigna but our IVIG decisions are made through Walgreens because that is the pharmacy the hospital I work for contracts with. It will cost us a flat rate of $70.00 whenever we do it. We can have it whenever at no cap. Unbelievable. The hospital buys it in bulk so it is cheap. We are planning to do it every 4 months this year to stay where we are. We are doing great.

[GraceUnderPressure]

Can anyone recommend a good way to find a local or home infusion place? It appears that there are many here in the Houston area, but we'd like to have some idea that we're using a company that uses best practices, provides proper training, etc.

 

(We'd love to save money & avoid driving up to Dallas & staying overnight to do the 2-day infusion, but we're also nervous about winding up with some LabCorp-style operation that puts dollars before decent patient care)

[Phasmid]

Amy, I sure hope that you intend to go after Anthem for reimbursment, now that there is precedent! If they provide coverage for one patient for IVIG, then they really are obligated to provide for another, as long as both are equivalent policy (both PPO or both other). If not, then they can be charged with discriminatory coverage.

 

Conspire? I am starting to write the letter, replete with peer reviewed journal references. I think if we collaborate and pool our skills, we can turn out a good template that we all can copy and use. I have some science writing background.

 

 

[browneyesmom]

Grace... we used Acredo when she was doing the SubQ at home... turned out, of course, to not be nearly enough for what she needed and we're now doing HD IVIG with Dr. B; however, the Acredo nurse we were assigned was wonderful. We happened into that as that is who our insurance uses; I have no idea if they work with out of pocket situations, but it might be worth checking.

 

Phasmid... in that letter... one might want to compare/contrast the costs of repeated hospital admissions and even institutionalization (not saying that is what you're planning to do) as I suspect they may wish to re-consider when faced with the options they might have to cover. I was fully prepared to do battle and gather research literature on it as well as tell them they could choose one or the other. Please keep us posted.

[Phasmid]

This helps get through the new flu or pneumonia that my little guy has now. Talked to supervisor at Anthem. Anthem Blue Cross (PPO) just paid on the first infusion. I am left with 10% of the charge. I played dumb so she wouldn't go defensive. She said the reason there is a problem with the pre-cert for the second infusion is that dr indicated "unspecified immune" on the first pre-cert, but on that billing, there was more information, including another dx code. This time dr. indicated "immune deficiency" and "hypogammaglobulinemia." I think at that point, the reviewers smelled PANDAS, because apparently, PANDAS was not indicated as a diagnosis!

 

So, get this, she said, "They should just re-submit it with the original codes." Huh?