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Appeal with UHC denied


hawks

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United Healthcare denied our appeal for additional doses of ivig. They state that they do not cover repeated doses for PANDAS. I know I have asked this before but have others had success getting more that one dose covered. If so, and you have any info that would help us I would appreciate it. Geez we even used a lot of THENMAMA's great info/advice for the appeal. Bummer.

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One thing I would be sure to point out or have your docs point out is that IVIG wears off over time AND that new PANS flares can be triggered by new illnesses and exposures-- both strong reasons their "IVIG is a one shot deal" policy makes no medical sense...

 

But since your first appeal has been denied I think it'd be advisable to carefully research your remaining appeal options and any potential missteps on their part that might strengthen your case before you do anything else. Doesn't hurt to have an ace in your back pocket that they know you're sitting on-- then you can hope they're willing to deal to keep you from playing it regardless of the policy loopholes against coverage, etc.

 

Also-- look very carefully at all of your plan documents--is it stated outright anywhere that they will only cover IVIG once for PANS? If not, they're making the rules on the fly and I can suggest some next steps depending on the type of plan you have (self-funded or fully insured).

 

TH

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