Won the insurance battle, lost the war

[cobbiemommy]

Friday, we received two envelopes from insurance company. Envelope number one: they are paying on most recent claim for preapproved HD IVIg (October, 2012) If they pay for one in the series, they will have to pay for all (three total). It was precertified and they should have been paying all along.

 

Envelope number two: Doctor that prescribed HD IVIg is no longer a preferred provider with that insurance company.

 

The reason I feel we lost the war with the insurance company is that: original preapproval for IVIg ended in May of 2013 and DS only received 3 of the possible 6 HD IVIg he could have had because insurance would not pay. His condition deteriorated during that time and now that we know they will pay if forced; the doctor is out of network. As if PANDAs is not bad enough, we have to be abused by the insurance company as well. This whole situation has turned me into a very bitter person.

[T_Anna]

That's horrible! I wish I had suggestions.

 

What insurance, maybe there is another pandas doc who can help.

 

T.Anna

Ds15

[MomWithOCDSon]

I'm so sorry! That stinks! Not to insult anyone here who might be affiliated with health insurance companies, but I despise them all. Not equally, necessarily, but despise them all nonetheless. Profit should not be in the equation when it comes to healthcare, and that's all these companies care about. They're not in business for our benefit (much as their PR departments would say otherwise), and they're not in business for the benefit of our providers, either. They answer to their boards and their stockholders. It is a stupid system, rife with conflicts of interest. Sorry for the rant, but stories like yours are way too frequent.

[cobbiemommy]

Our new immunologist is in network with Cigna. If I lose my job (highly possible), the doc is also a provider for DH insurance company (BCBS). New doc seems more savvy to the whole insurance run around. He knew right away what we would do if insurance would not pay. The costs at his office seem much more reasonable as well, so we shall wait and see.

 

I despise all insurance companies at this point.

[mdmom]

Sorry you are having to fight so hard...I completely understand. I had to fight most of last year to get my insurance company to approve IVIG for my son (who has a valid immune deficiency).

 

Just wanted to point out that for us, it doesn't matter that the doc ordering the IVIG is out of network. Our LLMD (who is out-of-network) orders IVIG and an in-network infusion company sends a nurse to our home to administer the IVIG.

 

Can you get the doc to order it for home infusion?

[cobbiemommy]

I think we are just going to go forward with new immunologist, since he is within driving distance of our home. We are not to the prescribing point yet for IVIg. We have a follow up in two weeks for labs and to go over what other specialists think. I am really trying not to look back--just forward. The good thing is that we will not have a large balance to pay a doctor for IVIg that happened in the past.

Sorry you are having to fight so hard...I completely understand. I had to fight most of last year to get my insurance company to approve IVIG for my son (who has a valid immune deficiency).

 

Just wanted to point out that for us, it doesn't matter that the doc ordering the IVIG is out of network. Our LLMD (who is out-of-network) orders IVIG and an in-network infusion company sends a nurse to our home to administer the IVIG.

 

Can you get the doc to order it for home infusion?

[tpotter]

If you can't get someone in-network (preferred provider) to provide the HD IVIG, I believe insurance is required to pay out of network. Several years ago, I got a neuropsych eval paid that way (they didn't have an in-network provider.) I am not certain about this, but certainly worth a look.