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anyone paid out of pocket for IVIG


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I cannot get a "for sure" answer if my insurance (CIGNA) will cover IVIG for my child.

Weight is about 120lbs.

My insurance does not require pre-authoriztion for IVIG (the ordering doctor's scheduler checked that part out) so I really do not know how this is going to go. If we go there & ins denies it-- I am wondering:

 

1. general cost

 

2. do they cut any breaks if you ending up owing them?

 

thanks in advance for any advice

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HD IVIG cost $15,000 for a child about that size with Dr.K. I don't know what it costs at Georgetown. You usually do get a break when paying cash. This had to be paid up front though - no payment plans. Dr.K requires payment upfront even if pre approved by insurance company.

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Guest TwinCitiesMom

I cannot get a "for sure" answer if my insurance (CIGNA) will cover IVIG for my child.

Weight is about 120lbs.

My insurance does not require pre-authoriztion for IVIG (the ordering doctor's scheduler checked that part out) so I really do not know how this is going to go. If we go there & ins denies it-- I am wondering:

 

1. general cost

 

2. do they cut any breaks if you ending up owing them?

 

thanks in advance for any advice

 

Cigna just released its Policy regarding IVIG this past week. Anyone with Cigna needs to take a look.

 

Our 14yo DS had IVIG summer 2010 with Dr. K. We have Cigna. Feel free to PM me if you have any questions.

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We are looking into possibly having to pay out-of-pocket for our son as well if insurance denies PEX/IVIG. The cheapest quote I got was from Crest in New Jersey (our closet location (though two hours away), but they have many others). They also do home infusions and would come to our home. They basically are willing to give us IVIG at the cost they would have gotten through our insurance company. Our son is about 115 lbs. and they gave me an estimate of $8,300. I was very impressed with the people at the New Jersey location. The pharmacist is wonderful, and he went to a lot of trouble to try to understand PANDAS--he had never heard of it.

 

But I would think if pre-authorization is not required, that is a good thing. Doesn't that mean if a doctor orders IVIG, they have to pay for it? I wish my insurance didn't require pre-authorization. We are waiting for pre-authorization now.

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We have paid out of pocket for our IVIG's. We had them done at our local Coram Center (chain of IV infusion places across the US)

I was very pleased with the care, professionalism, and price. And, 20 minutes from our house.

Our ordering Dr. knew exactly how to write the prescriptions, and spoke each time with the pharmacist at the Coram Center- Coram people knew what they were doing.

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I can get it done somewhere else for less money- but I have to pay up front.

My theory- admittedly untested- is that if the insurance is billed by a hospital they are more likely to pay then if I personally file for a claim after the fact.

 

However, I am looking at a $7000 error- if they deny!

my dilema is this:

 

1. pay up front about $8000 and hope they approve my claim for reimbursment

 

or

 

2.go to hospital and hope like heck they pay and if not, I will be on the hook for the whole amount at least $15-16K.

 

any words of wisdom?

 

also- does everbody get bloodwork done in preparation for IVIG? like immunological panels? we are not seeing a immunologist, so maybe that is why we have not done any of that.

 

ANY SAGE ADVICE??

 

Oh, I have no sage advice ;-)

Yes, we had to have an immune panel run before our Dr. would prescribe a IVIG- 1.) to check the IgA level, make sure it was in range 2.) If you do have immune def. you probably will get it covered by insurance.

I'm no expert--best wishes--

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