Cigna denial

[beeskneesmommy]

Oh #@&%$# !! Just got the word that Cigna denied IVig d/t it being "experimental treatment for PANDAS". This seems to be happening a lot with Cigna recently. I am so frustrated and worried! I already started getting ready for the 1st appeal, but I would really like to know if anyone out there has been approved by Cigna over the past couple of months since the new medical director started over there....please send up prayers for us!!

[thenmama]

Do you know who the new medical director is? We dealt with a med director who'd denied our daughter's IVIG and left for a job with Cigna while we were in the appeals process.

[beeskneesmommy]

Will PM you, thenmama.

[Kiera]

I'm almost ready to send in my level 2 appeals letter (thank-you thenmama for all the tips!)and supporting documents to cigna, all 70 pages!! From my research online, some cigna co.s have covered it, if the co is self-insured and the plan is simply run by cigna, as is the case with our co. Since cigna specifically excludes IVIG for pandas, they are legally within their rights to refuse as per their policy, but the level 2 appeal will go to a committee for review, and it is my understanding the final decision lies with the company's corporate level people, which gives us a better chance. I shoud know within a few weeks and I'll keep you posted!

[beeskneesmommy]

There is a level 1 appeal, reviewed by a Cigna group. Then there is a level 2, also reviewed by a Cigna group, but a different group of people. if both of these are denied, there is a level 3, which will be reviewed by an outside mediation company. If level 3 is denied, there is no recourse. However, if you can hang in there and get to level 3, your chances may be better. This is what I am counting on. In addition, IVig is not technically excluded as a PANDAS treatment for all Cigna plans, including ours, from what I understand through my husband's HR. They are just choosing to deny. They made us get a specialized blood test in order to submit the request for approval and my son "failed" it. However, the test is also an experimental research tool that has an unreliable outcome...go figure. They are just playing games.

[Nearlydoc]

We have Cigna through FedEx, and our ready to try IVIG. The insurance will pay for PEX but not for IVIG. This is so frustrating. We are building a team of specialists to help us make our case. I really appreciate all of you sharing your experiences with this situation. Thanks.

[szcasey]

We have Cigna through FedEx, and our ready to try IVIG. The insurance will pay for PEX but not for IVIG. This is so frustrating. We are building a team of specialists to help us make our case. I really appreciate all of you sharing your experiences with this situation. Thanks.

[szcasey]

The approval process is so frustrating! We just switched to CIGNA and are in the early stages of appeals. I've attached CIGNA's IVIG medical policy. Page 8 of 33 lists exclusions...

 

Good luck!

 

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[szcasey]

First link to to CIGNA's PDF didn't work... 2nd attempt. My apologies. I am not too familiar with this site...

 

http://www.cigna.com/assets/docs/health-care-professionals/coverage_positions/ph_5026_coveragepositioncriteria_Immune_Globulin_Intravenous_IGIV.pdf

[minimaxwell]

Swedo has told me her first choice to treat PANDAS is PEX. I would go for that.

[tapiash]

Oh #@&%$# !! Just got the word that Cigna denied IVig d/t it being "experimental treatment for PANDAS". This seems to be happening a lot with Cigna recently. I am so frustrated and worried! I already started getting ready for the 1st appeal, but I would really like to know if anyone out there has been approved by Cigna over the past couple of months since the new medical director started over there....please send up prayers for us!!

 

We did but our doctor listed the condition as an autoimmune disorder and encephlatic "symptoms" The medical request did not have PANDAS diagnosis.

[beeskneesmommy]

PEX is not appropriate for my little boy at this time. He has an unusable exit vein. He would need a port which would lead to a higher risk of serious infection and the lengthy time that that it would have to be in would add to trauma. IVig is much less expensive for his case as well as much less intrusive and traumatic. Go figure.

[tpotter]

We have Cigna through FedEx, and our ready to try IVIG. The insurance will pay for PEX but not for IVIG. This is so frustrating. We are building a team of specialists to help us make our case. I really appreciate all of you sharing your experiences with this situation. Thanks.

 

 

If they'll pay for PEX, is there any way you can get that? It's not a blood product, actually worked better on the NIMH study, and tends to work quicker. We have done both (only go the PEX once, but would have done it more if we could have gotten it.) Don't get me wrong, the IVIG helped, too, but I would definitely choose PEX over IVIG for my children if given the chance.

[Kiera]

We have Cigna through FedEx, and our ready to try IVIG. The insurance will pay for PEX but not for IVIG. This is so frustrating. We are building a team of specialists to help us make our case. I really appreciate all of you sharing your experiences with this situation. Thanks.

 

 

If they'll pay for PEX, is there any way you can get that? It's not a blood product, actually worked better on the NIMH study, and tends to work quicker. We have done both (only go the PEX once, but would have done it more if we could have gotten it.) Don't get me wrong, the IVIG helped, too, but I would definitely choose PEX over IVIG for my children if given the chance.

According to Dr B, PEX still needs to be followed by IVIG as it removes ALL the antibodies, good and bad, so you've no antibodies left to fight infection and you're still left with the same problem of insurance not covering IVIG. Don't know how true this is though.