IVIG through Cigna

[Kiera]

Hi everyone,

Has anyone had success getting IVIG covered through Cigna? I seem to remember reading that it was covered somewhere?? I've just received denial again, due to "off label" and am appealing again. Need more ammo for next letter, would be great to include instance where it has been covered previously so precedent has been set. Thanks to thenmama for posting her appeals letters, was a big help, but still need more:(

[Dedee]

I don't want to be discouraging. Keep trying. We were denied over and over. Our physician even did a peer to peer review. That was denied also. We went to the National Appeals Committee (my husband is a lawyer)......Denied. It was a very stressful time for us. Problem is that the plan has a statement that says that IVIG is not used for PANDAS and my daughter already had PANS in her chart. Now if you can get it in under a diagnosis like CVID or something else you have a chance. My doctor is currently working on making a clinical case for CVID for us. If we can prove that then they will most likely approve it. That would be my recommendation. Also, our integrative medicine practitioner says when you show letters by three different physicians saying that the IVIG would be beneficial, it increases your chances. Something about liability of withholding treatment repeatedly deamed necessary. So that would be like your pediatrician, neurologist, and PANS specialist for instance. (Just throwing specialities around). I hope your are able to get this through. Best of luck.

 

Dedee

[Nearlydoc]

Hi Kiera,

 

We are working though Cigna as well. I would appreciate any info you might have.

 

 

Debbie

[Kiera]

Right now I'm in the process of getting together all my papers to submit to the level II appeal committee. Our health plan is actually self-insured by the employer and Cigna runs the plan, which means the final decision lies with the employer's corporate dept and they have the lee-way to allow coverage or not. I think this helps our case but I'm not holding our breath! We self-paid already and are trying to get re-embursement. I'll keep you posted. PM me for specifics.