IVIG Denied!

[Kiera]

Just received denial letter from Cigna for 1st ivig through local Dr! So bummed right now. Seriously considering just going to Dr K who has the experience in getting it covered. Anyone here get ivig through Dr K covered with cigna?? Thanks.

[PowPow]

I do not go to dr K, but I thought he did NOT work with ins. I thought everyone paid upfront and then asked for reimbursement themselves. This is again, from someone who is not a patient of his.

However, what is the diagnosis your child was given- the code used for IVIG?

I think Dr B might work with ins and some insurance also with Dr L (she uses a local hospital usually)

[Kiera]

I have 2 friends who've gone to Dr K, he gives you codes to use to get pre-approval and writes a letter of necessity, must have letter of pre-approval in hand prior to ivig, only part is paid cash up front and then re-embursed post. Otherwise, if for whatever reason you're not dealing with insurance then you just pay all in cash. Don't know what codes local Dr used, teying to find all that out now!

[PowPow]

I will PM you some info- I have Cigna

[BoyIowa]

I have Cigna too, but not the 'beech street" Cigna - I think it is different. We are waiting to see if they cover our IVIG. I have been praying every day. I am trying to get prepared and gather ammo if we get denied. Powpow, I would appreciate anything that you could share.

[JMTho]

These were the codes our specialist used when submitting letter of necessity to our insurance; there are NO codes for PANDAS/PITAND/PANS:

 

• 279.9

• 348.30

• 348.39 NEC

 

He also listed specific symptoms exhibited by our ds in his letter.

 

CIGNA does list PEX as approved for PANDAS in their information online; however, they exclude IVIG for PANDAS.

[BoyIowa]

I did see the literature from Cigna that says PEX is considered medically necessary for Pandas. However, I have seen that several kids have IVIG after PEX. Is that necessary? I would be concerned about going for the PEX if our Cigna wouldn't cover the IVIG if it is needed too.

[Kiera]

Doesn't make sense to me that they would cover pex but not ivig since pex is much more invasive and in the long run would cost more than ivig (I'm sure cost is the defining factor!). JMTho thanks for your info. I'm going to hound them anyway until I get it. Local pandas Dr is trying (my ds is 1st ivig for pandas) but obviously she needs to learn the politics of it also, sigh!