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My husband is looking at a new job and I asked him some questions about their insurance policy.

 

We have UHC PPO and had an IVIG with Dr. K last summer...it was approved.

 

This potential job is with a national company who offers BCBS PPO. It calls their whole health care an Allegis Group and has info on Carefirst.

 

So, does this differ from the info that I'm seeing with peoples' plans being listed as BCBS of State XYZ? We live in Illinois but the company the job is for is national and the benefits policy says "No matter how well you take care of yourself, medical issues will arise. With Allegis Group’s CDHP, you are

covered by the BlueCross BlueShield Preferred Provider Organization (PPO) plan.

With our BlueCross BlueShield PPO plan, you do not need to choose a primary care physician and referrals are not necessary.

You have access to see a healthcare professional inside or outside of the national BlueCross BlueShield PPO network."

 

So, is this different? What kind of results have people got with national BCBS PPO for IVIG (I anticipate DS1 will need another).

 

So confusing. We've been with UHC for 18 years now and I don't want to change.

 

Thanks!

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I have no experience getting IVIG covered but I will let you know there are differences. We have BCBS PPO in Michigan. We also don't need a primary care or referrals. We have in network where the dr agrees to accept the payment in full from BCBS and out of network, where our particular policy pays only 60% of reasonable and customary, so you would be out 40% of the cost BCBS contracts for plus pay anything over that amount that the dr or hospital charges.

 

You've got to read your policy to know. Also, dh's employee is a huge national corp and it self insures and pays BCBS to administer the policy. Each company can choose or refuse riders to the policy and tweek the policy to fit their needs.

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My husband is looking at a new job and I asked him some questions about their insurance policy.

 

We have UHC PPO and had an IVIG with Dr. K last summer...it was approved.

 

This potential job is with a national company who offers BCBS PPO. It calls their whole health care an Allegis Group and has info on Carefirst.

 

So, does this differ from the info that I'm seeing with peoples' plans being listed as BCBS of State XYZ? We live in Illinois but the company the job is for is national and the benefits policy says "No matter how well you take care of yourself, medical issues will arise. With Allegis Group’s CDHP, you are

covered by the BlueCross BlueShield Preferred Provider Organization (PPO) plan.

With our BlueCross BlueShield PPO plan, you do not need to choose a primary care physician and referrals are not necessary.

You have access to see a healthcare professional inside or outside of the national BlueCross BlueShield PPO network."

 

So, is this different? What kind of results have people got with national BCBS PPO for IVIG (I anticipate DS1 will need another).

 

So confusing. We've been with UHC for 18 years now and I don't want to change.

 

Thanks!

 

You could call the health insurer and ask them to send you their policy (complete book) in writing, including their policy toward IVIG. If your child has immune deficiencies you might have a chance at another IVIG. UHC covers IVIG for PANDAS, but most insurers specifically state that IVIG for PANDAS is experimental and is NOT covered.

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My husband is looking at a new job and I asked him some questions about their insurance policy.

 

We have UHC PPO and had an IVIG with Dr. K last summer...it was approved.

 

This potential job is with a national company who offers BCBS PPO. It calls their whole health care an Allegis Group and has info on Carefirst.

 

So, does this differ from the info that I'm seeing with peoples' plans being listed as BCBS of State XYZ? We live in Illinois but the company the job is for is national and the benefits policy says "No matter how well you take care of yourself, medical issues will arise. With Allegis Group’s CDHP, you are

covered by the BlueCross BlueShield Preferred Provider Organization (PPO) plan.

With our BlueCross BlueShield PPO plan, you do not need to choose a primary care physician and referrals are not necessary.

You have access to see a healthcare professional inside or outside of the national BlueCross BlueShield PPO network."

 

So, is this different? What kind of results have people got with national BCBS PPO for IVIG (I anticipate DS1 will need another).

 

So confusing. We've been with UHC for 18 years now and I don't want to change.

 

Thanks!

we just changed to anthem blue cross and blue shield ppo and ivig is covered under my dd's circumstances. This was done through dr. B.

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We have BCBS MI and our policy covered a percentage of IVIG #1 last June 2010 and dh called yesterday and they said it would be covered (you know, the percentage they cover) again for IVIg #2 next week. But it is hit or miss with how each policy is written and thus requires a diligence that we, the consumer, often finds too challenging and complex to feel comfortable with any answer we might stumble upon while assessing the details.

 

And, sadly, we have to figure this insurance business all out in the midst of trying to just make it through the day when our PANDAS children are less than functional.

Mary

from Michigan

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It depends upon the diagnosis / diagnositic codes used for billing.

 

if your child has a true primary or secondary immunodeficiency syndrome and meets all of those true lab criteria, there is a good chance you will be ok'd by your insurer. you can actually google your insurer and IVIG and pull up their criteria for ivig reimbursement, its on their website somewhere.

 

the thing is that many pandas kids do not meet those exact criteria. i'm sure there are other yet-to-be-named immunodeficiency syndrome criteria they would meet, but as of this moment, a diagnosis of pandas does not imply coverage for ivig for the most part. in fact there is not a diagnostic code yet for pandas, which is wrong!! There are codes for autoimmune disease not elsewhere classified or immunodeficiency not elsewhere classified, but they are not usually reimburseable unless you really fight with your insurance company. some people are able to get coverage once declined just by fighting it.

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This sounds almost like the system we just had in place at my employer (they just swtiched to UHC as of March 1st) - a regional engineering firm. We were "self-insured". Which means that the company paid out all claims through a third party benefits administrator. But we were still associated with a "network" of Dr's through Evolutions insurance. Evolutions didn't process our claims, but we paid them a much smaller fee to use their pre-negotiated rates with their service providers. It was a very comprehensive plan, and what was covered/not covered wasn't determined by evolutions, but by the company policies - administered through the benefits administrator. We didn't have to go the IVIG route, but if it wasn't covered, I would've had to appeal to our internal benefits/HR department - not the insurance company. The company I worked for previously, which was a large national firm, was also self insured, and used BCBS as their network, but they also used them as their administrators as well.

 

Could it be that Allegis Group is their thrid party benefits administrator and BCBS PPO is their network?

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