which insurance covers iv

[melanie]

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?

 

Is Cinga better

 

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

[EAMom]

PPO United Health Care has been good for us (knock on wood) esp. compared to the Healthnet HMO we had when dd 1st got sick The HMO did end up covering things (I'm pretty sure it would NOT have covered IVIG!!) but it took a lot of convincing work on dh's part (eg getting our psychiatrist covered).

 

I don't have personal experience with the others...although I've heard not-so-good things about Aetna on this forum.