Insurance coverage for IVIG

[hawks]

For those who have had insurance successfully cover ivig - who is your Insurance carrier. We are up for renewal with our insurance for our small business and we will be looking at other carriers before we make a decision on who will be our carrier for this year. We currently have United Healthcare and we are in the process of getting the preauthorization. Based on the the recommendation of 2 pandas docs we are heading in the direction of IVIG. Because one of these docs suggested multiple IVIG's we wanted to make sure that we get the best insurance coverage possible. Thanks for your help.

[BoyIowa]

I too share the quest. I found this on the web and I think CareAllies is the network that my Cigna uses.

 

http://www.careallies.com/pdf/EX169_plasmapheresis.pdf

 

Not sure what is more effective: Plasmapheresis or IVIg? I have asked the question on another post:

 

http://www.latitudes.org/forums/index.php?showtopic=15288

[HT's Mom]

We have Anthem BC/BS in Virginia. I had feared there would be no coverage, as i had seen a number of posts that Anthem did not cover other members' IVIG's, or they had to fight hard, etc. But amazingly after having IVIG with Dr. K in May 2011, and paying for everything up front, we did get almost full reimbursement of the hospital portion of the bill. Dr. K's fee was only reimbursed a few hundred $. Turns out he is "in-network" with Anthem so they only paid back the allowable charges. But Anthem paid the hospital a lot more than we had paid up front. All very confusing and suspicious, but we were grateful for what we got!

[nicklemama]

BCBS MI PPO. Oakbrook in Chicago was in network. I called for preapproval and was told IVIG didn't require preapproval. I had absolutely no hope they'd actually cover it but they did. Did not cover Dr K's fee.

[mdmom]

It's not coverage for IVIG you need to be worried about. It's coverage for IVIG for PANDAS. BCBS considers this investigative treatment for PANDAS. Some on this forum have been succesful getting the treatment for this dx. Others, like me, have had no success. Some docs are getting insurance approval for IVIG based on immune deficiency diagnoses.

[HT's Mom]

Yes that's right. I don't think Dr. K's codes that were submitted were PANDAS specific. So they were for encephalitas or an immune problem.

[mtmom]

We have BCBS of Il. We tried to get preauthorization and was denied. the word PANDAS was used in the note documentation and PANDAS is on the do not approve list. Dr. K stated that sometimes after the treatment with his letter of improvement they will pay. We shall see. Keeping my fingers crossed. We paid everything upfront.

[hawks]

Thanks everyone for your help and suggestions regarding my insurance questions.