SEED OF HOPE - Anthem BC approval of IVIG

[amyjoy]

I'm running out the door so cannot get specific but must tell you that a child in our office just had a DENIAL of IVIG treatment funds OVERTURNED at Anthem BC. It took a gargantuan effort on the part of this mother and I can tell you more later, but it happened. And its HUGE for them, and for us, for all of us.

 

So DO NOT GIVE UP.

Amy

[Phasmid]

Well, this certainly is timely! I am just faced with denial, AFTER my son had his first infusion, and have about 6 years of pent up frustration and anger and worry and grief that I am very anxious to unleash on Anthem! Please do contact me when you have a chance and share what you know. Feel free to email me: marykatmit@gmail.com I am going to start printing all the papers I have saved up. I will need the help of someone who has been successful. That is WONDERFUL to hear.

 

Thanks Amy!

 

 

I'm running out the door so cannot get specific but must tell you that a child in our office just had a DENIAL of IVIG treatment funds OVERTURNED at Anthem BC. It took a gargantuan effort on the part of this mother and I can tell you more later, but it happened. And its HUGE for them, and for us, for all of us.

 

So DO NOT GIVE UP.

Amy

[advocatemom]

WOOT! WOOT! I'd love to know how she did it because I am just now stepping up to the plate to do battle with Blue Cross Blue Sheild Illinois.

[butterflymom]

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Edited February 3, 2016 by butterflymom

[Phasmid]

Thanks Tampicc!

 

 

In case this is helpful to any of you applying for /appealing insurance coverage, found this statement on the PANDAS network IVIG page:

 

the American Academy of Allergy and Immunology advocates in "The Work Group Report" the use of IVIG for PANDAS.

 

this link gets you there:

 

http://www.aaaai.org...atives/ivig.stm

 

Then click on the 'AAAAI Work Group Report'

[Iowadawn]

Our success BCBS in Iowa has been after much squeaking. It didn't come so much with the help of docs, rather with the benefits dept and my husband's employer's BCBS rep. A little emotion and demonstrating how they are cutting off their nose to spite their face (e.g., paying for meds that are not approved for our age of child, multiple hospital stays, ambulance rides...stuff that hasn't worked) Demonstrating how he responded to the first one and now look at him. How Aetna & UHC & Canada recognize it's efficacy. And then throwing it on to their shoulders....If you don't like what my doctor is recommended as treatment for this disease and everything we have tried isn't working, please tell us what treatment you would recommend that will work and you will pay for, b/c my doc would like to know. Something along that line. Give them an emotional tug--my home & family bear the scars; the feeling of seeing your child purposely run out in traffic in front of a bus egging the driving to run him over; seeing your school-loving son become homebound and almost 2 years behind in school, etc. Just keep squeaking. Their job is to wear you down & hope you go away and give up. We PANDAS parents are not known for doing this! Dawn

[kimballot]

Our success BCBS in Iowa has been after much squeaking. It didn't come so much with the help of docs, rather with the benefits dept and my husband's employer's BCBS rep. A little emotion and demonstrating how they are cutting off their nose to spite their face (e.g., paying for meds that are not approved for our age of child, multiple hospital stays, ambulance rides...stuff that hasn't worked) Demonstrating how he responded to the first one and now look at him. How Aetna & UHC & Canada recognize it's efficacy. And then throwing it on to their shoulders....If you don't like what my doctor is recommended as treatment for this disease and everything we have tried isn't working, please tell us what treatment you would recommend that will work and you will pay for, b/c my doc would like to know. Something along that line. Give them an emotional tug--my home & family bear the scars; the feeling of seeing your child purposely run out in traffic in front of a bus egging the driving to run him over; seeing your school-loving son become homebound and almost 2 years behind in school, etc. Just keep squeaking. Their job is to wear you down & hope you go away and give up. We PANDAS parents are not known for doing this! Dawn

 

 

Dawn - YOU GO GIRL!

[amyjoy]

WEll, this mom was the insurance company's total nightmare of persistence. She literally scheduled in two hours each morning to talk on the phone to Anthem. She quickly dismissed the case manager and the case manager's manager as being completely powerless. She started calling the office of the President of Anthem and insisted on talking with her. She called every day and pushed and pushed. She did this a couple of years ago as well, when her child was dx'd with Lyme and they needed to get very expensive bicillin shots covered, and finally she did get through to the president of the company. After telling her of the nightmares of trying to do business with her company while her child was ill and suffering, the president herself ended up ok'ing it. This mom had been told by a number of people in Anthem that these antibiotics will NEVER be coverd and she said, just watch i'll get it covered.

 

Anyway a couple of weeks ago, she finally reached someone in the president's office about this IVIG denial, who became willing to listen to her and ultimately, he is the one who made it happen. While at first it sounds like he did what she asked him very begrudgingly, he did explain in detail what they were wanting in her son's file. Every time he said to her...."now call the doctor and ask him to send us such and such..." she said no, YOU call the doctor....YOU do the follow up, this is what I am paying your company for." And she constantly made it personal..."what if this was your child suffering, what would you do??". Then today, he called her told her the great news, the denial has been overturned.

 

I have asked her to share this person's contact info, and she felt she needed to ask him first, if this would be ok. And if not, to give us the contact person who would help us deal with this as there are many kids out here needing our denials overturned.

 

She also wrote a letter to the insurance commissioner, to her senator and to the governor's office as well.

 

These are all things that we can do.

 

I'm hoping to get the name of a contact high up in Anthem that we can connect to. I'll let you know what happens with that.

[Bordercollie]

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Edited January 29, 2011 by Bordercollie

[Bordercollie]

http://www.bcbs.com/news/plans/pam-kehaly-named-president-of.html

Here is the notice of the new President to Anthem BCBS. Good Luck.

[browneyesmom]

We also have approval through Blue Cross of California, but it came with the help of docs (Immunologist here and Dr. and very wonderful office personnel in Dr. B's office. I was fully prepared to do battle and tell them they would be paying for longer term hospital admission if not approved, so take your pick, but didn't have to go down that road, thankfully.

 

I'd be happy to provide more info if anyone wants it... just PM me as I'm really out of it right now from our trip, but I'll notice a PM and make time for anyone here needing help if I am able to assist.