BCBS AND IVIG

[bubbasmom]

I really need help fighting with Anthem BCBS to get IVIG covered. The other two times we've done IVIG we had United Health Care. At least UHC acknowledges right in their policy that IVIG is the treatment of PANDAS. BCBS says its not. (they would only have to read my son's chart alone to see the evidence). But anyone with any input it would be appreciated!! email me

[3boysmom]

If you search past topics, I know that there was a topic about a month ago with helpful posts on fighting for insurance approval. Best wishes, Linda

[Stephanie2]

I just posted our story on the other discussion regarding bcbs federal...

[amyjoy]

We had one family get their DS's IVIG covered through Anthem BCBS in California after contacting their Senator to intervene on their behalf. That's about it. But I believe there is more and more precedent for it and for pushing for it.

 

But this is what i want to know - if one of those girls from LeRoy ends up needing IVIG, with all that press attention - do you think there is ANY WAY their insurance would deny that coverage???? That's what I'm waiting to see.

[Concetta]

I really need help fighting with Anthem BCBS to get IVIG covered. The other two times we've done IVIG we had United Health Care. At least UHC acknowledges right in their policy that IVIG is the treatment of PANDAS. BCBS says its not. (they would only have to read my son's chart alone to see the evidence). But anyone with any input it would be appreciated!! email me

[Concetta]

We have Florida BCBS and we had 5 rounds (should have been 6 but our 17 year old PANDAS son refused to go back!) of IVIG ALL approved. It was listed as being needed done for Immune Defficiency Disorder. We see Dr. Murphy here in FL but she referred us to an Immuniologist who ordered the IVIGs. Good Luck!

[Tamistwins]

I really need help fighting with Anthem BCBS to get IVIG covered. The other two times we've done IVIG we had United Health Care. At least UHC acknowledges right in their policy that IVIG is the treatment of PANDAS. BCBS says its not. (they would only have to read my son's chart alone to see the evidence). But anyone with any input it would be appreciated!! email me

both my children were approved with our previous bc/bs whih was an hmo and we got approved for IVIG and for out of network benefits. However, now that we have Anthem which is a ppo my daughter was denied. Apparantly my son was approved for a yr in error but they can not go back on their decision. I am upset I thought this insurance would be better since we do ave out of network benefits. Don't give up go for an appeal.

[melanie]

We have bcbs too. Have been getting ivs for 2 1/2 years under immune defiency fx

[tpotter]

We had one family get their DS's IVIG covered through Anthem BCBS in California after contacting their Senator to intervene on their behalf. That's about it. But I believe there is more and more precedent for it and for pushing for it.

 

But this is what i want to know - if one of those girls from LeRoy ends up needing IVIG, with all that press attention - do you think there is ANY WAY their insurance would deny that coverage???? That's what I'm waiting to see.

 

 

Yes, I do believe they may refuse to cover it, because DENT is still claiming it's all conversion disorder, and with all the PR that DENT did, and convinced the press that the huge number who had high strep, mycoP and lyme titers supposedly means nothing, I suspect it is going to be just as hard, if not harder (but I hope I'm wrong.)

 

Anyway, as far as the question about getting IVIG. I would try the following:

 

1) Submit documentation showing how IVIG helped (before and after.) Include observation, and titers (if the numbers went down, that helps show evidence.) Has your child gotten sick less often since getting the IVIG? Is he starting to get sick more often since not getting the IVIG? That's the type of information you need to prove.

 

2) Include studies that show that IVIG works (the 1999 Lancet study is the primary one, and the NIMH is now working on a 2nd one.)

 

3) Speaking of the NIMH, I would include a copy of the website, and highlight the part where they talk about IVIG helping these kids, and also where they mention that an ongoing study is occurring.

 

4) What is your child's dx? Is it PANDAS or is it some kind of immune deficiency. If you can get verification (from an immunologist) that there is immune deficiency, you have a much better chance of successfully fighting this. If that's the case, then look at your policy's specific requirements to get IVIG for that specific dx (they do list it.) If not, you will have to fight it based on "off-label" use, and that typically requires 2 studies that have been documented in major publications (they're just working on the 2nd now, but the NIMH website might help you.)

[mom24]

We had one family get their DS's IVIG covered through Anthem BCBS in California after contacting their Senator to intervene on their behalf. That's about it. But I believe there is more and more precedent for it and for pushing for it.

 

But this is what i want to know - if one of those girls from LeRoy ends up needing IVIG, with all that press attention - do you think there is ANY WAY their insurance would deny that coverage???? That's what I'm waiting to see.

 

 

Yes, I do believe they may refuse to cover it, because DENT is still claiming it's all conversion disorder, and with all the PR that DENT did, and convinced the press that the huge number who had high strep, mycoP and lyme titers supposedly means nothing, I suspect it is going to be just as hard, if not harder (but I hope I'm wrong.)

 

Anyway, as far as the question about getting IVIG. I would try the following:

 

1) Submit documentation showing how IVIG helped (before and after.) Include observation, and titers (if the numbers went down, that helps show evidence.) Has your child gotten sick less often since getting the IVIG? Is he starting to get sick more often since not getting the IVIG? That's the type of information you need to prove.

 

2) Include studies that show that IVIG works (the 1999 Lancet study is the primary one, and the NIMH is now working on a 2nd one.)

 

3) Speaking of the NIMH, I would include a copy of the website, and highlight the part where they talk about IVIG helping these kids, and also where they mention that an ongoing study is occurring.

 

4) What is your child's dx? Is it PANDAS or is it some kind of immune deficiency. If you can get verification (from an immunologist) that there is immune deficiency, you have a much better chance of successfully fighting this. If that's the case, then look at your policy's specific requirements to get IVIG for that specific dx (they do list it.) If not, you will have to fight it based on "off-label" use, and that typically requires 2 studies that have been documented in major publications (they're just working on the 2nd now, but the NIMH website might help you.)

We too have BCBS ---PPO. My DS is diagnosed as immune deficient. We get approved for a few then have to go for re-approval. Total approved is about 8 or 9 so far. Good Luck!!

[Iowadawn]

We have had BCBS here in Iowa. Fought for coverage, but have had several IVIG's now. We are on our second year with approvals for a year stretch at a time. Thenmama's past posts have been very helpful. I am confident that we avoided the initial denial by including some of the info she presented when we sought approval again in January Dawn.

[nicklemama]

We have BCBS PPO in Michigan. Doesn't require preapproval here. It has covered DS's one IVIG. I believe his diagnosis is/was post infectious encephalitis, but don't quote me.