which insurance covers iv

[melanie]

I can change insurance soon either bcbs,aetna or cigna which is beter?

[Suzan]

I can change insurance soon either bcbs,aetna or cigna which is beter?

 

I know the Aetna plan I currently have specifically says it will not cover IVIG for PANDAS.

[melanie]

I can change insurance soon either bcbs,aetna or cigna which is beter?

 

I know the Aetna plan I currently have specifically says it will not cover IVIG for PANDAS.

 

How can 1 insuance comp say yhey use iv for PaNDAS and another say its experimental?

[Suzan]

How can 1 insuance comp say yhey use iv for PaNDAS and another say its experimental?

 

I know, it's maddening. They basically admit it's real and say they won't cover it! I'm switching to United PPO in January. I imagine it's the same problem but I have not confirmed that yet.

 

Susan

[fuelforall]

United Health Care specifically says it covers IVIG treatment for PANDAS.

 

https://www.unitedhealthcareonline.com/b2c/...ulin_(IVIG).htm

[Suzan]

United Health Care specifically says it covers IVIG treatment for PANDAS.

 

https://www.unitedhealthcareonline.com/b2c/...ulin_(IVIG).htm

 

HOLY FRICKEN COW! Thank you! I pray there is not a loop hole.

 

Susan

[fuelforall]

United Health Care specifically says it covers IVIG treatment for PANDAS.

 

https://www.unitedhealthcareonline.com/b2c/...ulin_(IVIG).htm

 

HOLY FRICKEN COW! Thank you! I pray there is not a loop hole.

 

Susan

 

I know, I can't believe my company is switching from Aetna to UHC. Hallelujah.

[peglem]

HOLY FRICKEN COW! Thank you! I pray there is not a loop hole.

 

Susan

 

There is a disclaimer about variance of coverage, depending on which policy you have...and UHC has a bajillion choices when it comes to plans. We never know when we sign up exactly what we are/are not covered for. Very frustrating!

[fuelforall]

HOLY FRICKEN COW! Thank you! I pray there is not a loop hole.

 

Susan

 

There is a disclaimer about variance of coverage, depending on which policy you have...and UHC has a bajillion choices when it comes to plans. We never know when we sign up exactly what we are/are not covered for. Very frustrating!

 

 

Could you elaborate? I am getting the Buy-Up plan. I don't know much more than that. Why would one PPO plan give less than another?

[peglem]

HOLY FRICKEN COW! Thank you! I pray there is not a loop hole.

 

Susan

 

There is a disclaimer about variance of coverage, depending on which policy you have...and UHC has a bajillion choices when it comes to plans. We never know when we sign up exactly what we are/are not covered for. Very frustrating!

 

 

Could you elaborate? I am getting the Buy-Up plan. I don't know much more than that. Why would one PPO plan give less than another?

I don't know that much about how insurance works, but it seems to me that its purposeful chaos- so you don't know what you're getting. They have different premiums for different plans and different benefits as well. Maybe they all cover the same basic procedures, I don't know. There are different out of network dealios, out of pocket...I just know that monthly statement they send every month (UHC) to "help" me manage my medical expenses are very confusing. So, no, I can't elaborate, I just assume they'll try to deny anything they can!

[Suzan]

I called our insurance plan, the drug is covered and the procedure is listed for PANDAS as a procedure that would be considered. It needs pre-approval. This is way better than my old plan so I do have some hope anyway.

 

Susan

[fuelforall]

Hopefully my ds9's IGG subclass 1 deficiency will be the push that qualifies him.

[peglem]

Hopefully my ds9's IGG subclass 1 deficiency will be the push that qualifies him.

I think something like that really helps.

 

The UHC site shows 1st off that IVIG is covered for immune deficiency, with at least one infection attributed to the deficiency.

 

Right now, I'm trying to get approval from UHC for our upcoming Latimer visit (not til 1/8/10). I know she doesn't take insurance, but since we were referred to her by the rheumatologist who declined to treat her because he doesn't have the expertise, we may be able to get reimbursement under a "gap exception", since they don't have any closer, in network providers with the necessary expertise. Then my daughter has secondary insurance(state provided), APIPA, which is supposed to cover any additional expenses over what primary pays. The fun fact here, is that APIPA is a subsidiary of UHC! This is amazingly complicated, but I think we really have a good shot at getting this covered. They both say, though, that you have to show that there is not a in network provider who has the expertise to treat her....well golly, how in the world does one do that?

[EAMom]

Hopefully my ds9's IGG subclass 1 deficiency will be the push that qualifies him.

I think something like that really helps.

 

The UHC site shows 1st off that IVIG is covered for immune deficiency, with at least one infection attributed to the deficiency.

 

Right now, I'm trying to get approval from UHC for our upcoming Latimer visit (not til 1/8/10). I know she doesn't take insurance, but since we were referred to her by the rheumatologist who declined to treat her because he doesn't have the expertise, we may be able to get reimbursement under a "gap exception", since they don't have any closer, in network providers with the necessary expertise. Then my daughter has secondary insurance(state provided), APIPA, which is supposed to cover any additional expenses over what primary pays. The fun fact here, is that APIPA is a subsidiary of UHC! This is amazingly complicated, but I think we really have a good shot at getting this covered. They both say, though, that you have to show that there is not a in network provider who has the expertise to treat her....well golly, how in the world does one do that?

 

I think you just have to go through their list of "approved providers"...call them and see if they have the expertise/availability to treat your dd...then you have to call UHC and say "look I spoke to these 20 doctors on this list of yours and none are willing or qualified to treat so you need to cover this one who is". If you ask a doctor what their experience is with treating PANDAS with PEX/IVIG and they answer "none"...then that's an easy strike off the list IMO. Maybe dh (Buster) can explain this better. We went through something similar with our HMO when dd first got sick. There were no psychiatrists qualified (by their own admission) to treat a 7 year old with anorexia nervosa....so we were thus able to get coverage for our out-of network OCD specialist child psychiatrist.

[matis_mom]

Hopefully my ds9's IGG subclass 1 deficiency will be the push that qualifies him.

I think something like that really helps.

 

The UHC site shows 1st off that IVIG is covered for immune deficiency, with at least one infection attributed to the deficiency.

 

Right now, I'm trying to get approval from UHC for our upcoming Latimer visit (not til 1/8/10). I know she doesn't take insurance, but since we were referred to her by the rheumatologist who declined to treat her because he doesn't have the expertise, we may be able to get reimbursement under a "gap exception", since they don't have any closer, in network providers with the necessary expertise. Then my daughter has secondary insurance(state provided), APIPA, which is supposed to cover any additional expenses over what primary pays. The fun fact here, is that APIPA is a subsidiary of UHC! This is amazingly complicated, but I think we really have a good shot at getting this covered. They both say, though, that you have to show that there is not a in network provider who has the expertise to treat her....well golly, how in the world does one do that?

 

I think you just have to go through their list of "approved providers"...call them and see if they have the expertise/availability to treat your dd...then you have to call UHC and say "look I spoke to these 20 doctors on this list of yours and none are willing or qualified to treat so you need to cover this one who is". If you ask a doctor what their experience is with treating PANDAS with PEX/IVIG and they answer "none"...then that's an easy strike off the list IMO. Maybe dh (Buster) can explain this better. We went through something similar with our HMO when dd first got sick. There were no psychiatrists qualified (by their own admission) to treat a 7 year old with anorexia nervosa....so we were thus able to get coverage for our out-of network OCD specialist child psychiatrist.

This is definitely something I am going to have to look into. Cigna as been good at reimbursing 70% of out-of-network providers, but seeing that we have a long road ahead of us, I am going to look into having them cover more if there is no qualified in-network specialists... Thanks for the wisdom!

 

Isabel