HELP The insurance company said no

[melanie]

Im on hold with the insurance company now.They said no to the second IV !! What do i do???

[bronxmom2]

was he diagnosed with a primary immune deficiency?

[melanie]

was he diagnosed with a primary immune deficiency?

 

 

I thougt so? I have to wait for the neuro to get in to the office My insurance company said ivig is experimental for pandas But they approved it in aug so why is it now 1 1/2 later?

[faith]

what was the reason they denied? what dx did your doc give? I thought he was on board with doing more IVIG for you?

[melanie]

what was the reason they denied? what dx did your doc give? I thought he was on board with doing more IVIG for you?

 

 

Im scheduled to go tomorrow! The insurance company denied the claim thoughHe has to do a peer to peer thing.I dont think he wants to .Hes not in yet.The office says they will talkto him when he gets in about 10am.The problem is danny doesnt have the strep titers #s to prove this My point is they approved it already so the #s didnt change

[bronxmom2]

it's experimental for pandas but not pid

[melanie]

it's experimental for pandas but not pid

 

Im waiting for the dr to call how do i get him to say pid he had a ton of blood work I havent recieved any results he did have iv when he was 3 or 4 they came to my house for about 6 months Im upset

[KeithandElizabeth]

Hi Melanie:

 

I think that many doctors are using an unknown autoimmune diagnosis or an immune deficiency diagnosis instead of a PANDAS diagnosis to get insurance to cover the cost. PANDAS is just too controversial right now for most insurance companies to cover the cost. Ask if they can change the code used. Every doctor has a different idea as to why these children get this illness, but many immunologists say something is not quite right with the immune system and whenever your body attacks its own self, then this is usually considered autoimmune - hence, the generic autoimmune diagnosis. This is what our doctors used to get insurance to cover our IVIG's.

 

Good Luck!!!!!

 

Elizabeth

[melanie]

Hi Melanie:

 

I think that many doctors are using an unknown autoimmune diagnosis or an immune deficiency diagnosis instead of a PANDAS diagnosis to get insurance to cover the cost. PANDAS is just too controversial right now for most insurance companies to cover the cost. Ask if they can change the code used. Every doctor has a different idea as to why these children get this illness, but many immunologists say something is not quite right with the immune system and whenever your body attacks its own self, then this is usually considered autoimmune - hence, the generic autoimmune diagnosis. This is what our doctors used to get insurance to cover our IVIG's.

 

Good Luck!!!!!

 

Elizabeth

 

OK Ive spent the morning on the phone with the md.He now says there was a study that came out last week that included 50,000 patients treated with iv and basiclly it doesnt work.I beg to differ .I dont understand what happend he oked the 2nd one now since the insurance comp said no and he has to call he doesnt think iv every 6 weeks is the right thing .My husband called the office and freaked the dr wont take his call had the girls read 2 lines from some resent study which my husband couldnt understand.We googled this study cant find the information anywhere.We have an app to see him on thursday.I am in contact with an immunologist.I can see her this week what do I need to do to gwet him a dx of immune diff.?HELP

[mama2alex]

I'm really sorry this is happening to you. I'm not sure what to tell you, but hang in there! If the doctor prescribed it already and the insurance co already covered it once, you should be able to get coverage again. You may just have to fight for it this time. Don't give in. Good luck.

[melanie]

I'm really sorry this is happening to you. I'm not sure what to tell you, but hang in there! If the doctor prescribed it already and the insurance co already covered it once, you should be able to get coverage again. You may just have to fight for it this time. Don't give in. Good luck.

 

I have an appointment at the immunologist tomorrow.Im hoping to get proof hes immune deficient. What do I ask him to test for?

Melanie