IVIG and Cigna

[Nearlydoc]

I know there was a thread way back about this, but I was hoping for some updates. We just got our first refusal from Cigna for IVIG ordered by our neurologist. I was wondering if anyone had a successful appeal, and if so, what might have been the key in gaining approval. DD7 has had PANDAS since she was 3. Her case is mild on the PANDAS scale, but the learning challenges are significant. We thought they would say no, but eternally optimistic me was hoping for a "yes."

[beeskneesmommy]

We were denied w/Bouboulis for Neuropsych d/o and then with Latimer for SD. The first was d/t "experimental treatment" and the 2nd was d/t "not medically necessary". Hah! We paid OOP w/Latimer and we are waiting for her to do a peer review. Cigna will not allow us to begin appeals process until the peer review is completed. I am starting to wonder if that is ever going to happen. We may just be out the cash.

[PowPow]

My daughters' had IVIG in 2011 for post-infectious encephalitis. We have CIGNA. One was covered (done at the hospital) and the other was done in Dr L's office, we paid OOP & were reimbursed a fair amount.

One of my daughter's also had a "footprint" approval for monthly IVIG and IV steroids for encephalitis- it was recommended treatment by Dr L and also neuros we saw for a second opinion at another hospital that is sort-of PANS friendly. We only did one or two of the monthly treatments before we changed our approach, anyway.

this was all in 2011, though. I heard that CIGNA is covering less and less now.

Please do not feel like IVIG is your only option if you have to pay OOP and cannot afford it. Maybe, just maybe, if the trial goes as well as we all hope~ it will be standard covered treatment soon!

 

edited to add : Sorry, just realized this did not at all address your question.

Edited November 3, 2012 by PowPow