IVIG Blue Cross Blue Sheild Illinois

[hazythecat]

Has anyone had sucess getting Blue Cross Blue Shield of Illinois to cover IVIG for pandas? BCBS denied coverage so we had to pay out of pocket. Trying to decide if it's worth going through the appeal process.

[melanie]

We have bcbsnj. Dan gets ivig every 21 days

[mdmom]

Does your child also have an immune deficiency diagnosis? Most insurance companies will cover IVIG for this, and some children with PANDAS/PANS also have a primary immune deficiency.

 

Have you read your medical policy for IVIG? Here is a link to one I found on-line for BCBS of IL:

 

http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=IL1&path=/templatedata/medpolicies/POLICY/data/RX/RX504.003_2011-03-15&ctype=POLICY&cat=Prescription#hlink

 

This specifically excludes IVIG for PANDAS, as many insurance companies do.

 

I just fought my insurance co (BCBS of MN) for IVIG for my son, but he has a dual diagnosis of PANDAS and CVID (Common Variable Immune Deficiency).

 

Search this forum for "thenmama" She has many posts offering tips for appealing your insurance company.

[sosudden]

We have BCBS of Kansas City. Denied coverage. Appealed. Denied appeal. Got IVIG in Chicago, Dr K. Paid out of pocket and would do it again as it brought our DD back from the edge, some symptoms resolved instantly. Here is the jacked up part - we got very minimally reimbursed for Dr K and for Oakbrook Surgical center BUT they would not reimburse at all for the actual IVIG?? Which of course is the biggest cost $$!!

There has to be a change sooner than later because IVIG is what a lot of our kids need!