Anthem Blue Cross & BS

[Joan Pandas Mom]

When my son was taking Zithromax 3-4 times a week I appealed Anthem's denial. He now is on Clindomycin for mycoplasma. Anthem got back to me today, (2 weeks later) with their denial. Their Rationale from their 2 review doctors was:

 

"PANDAS is a disorder that has been hypothesized on the basis of what is known about the relation of rheumatic fever to streptococcus. It is controversial whether it actually exists. The evidence can be interpreted differently. Those who believe it exists do not agree on its treatment. Consequently, whether the disease exists is controversial as is whether a prolonged course of Azithromycin should be used if it does. Per the current literature, routine administration of prophylactic antibiotics and/or IVIG is not indicated for children who meet PANDAS criteria"

 

WHEN ARE THESE PEOPLE GOING TO WAKE UP? Please send "Got Strep" cards to:Dr. Gary Myers and Dr. Richard Lafleur, Anthem UM Services, Inc., 3000 Goffs Falls Road, Manchester, NH 03111.

 

I'm really going to have fun if I try to do an IVIG later on.

[colleenrn]

I truly feel that if NIMH would get around to updating their very out of date web site this may not be so much of a problem. I feel is is extremely unfortunate for the children that physicians seeking guidance look to the NIMH web site and see that antibiotics are not warranted.

 

Colleen

[Megs_Mom]

Our doctors never write down PANDAS when prescribing. They note "unspecified autoimmune disorder" and OCD. Thus far (crossing my fingers) we have not had an issue with BCBS on Azith. Maybe try again, asking your docs to give another diagnosis. We went to an immunologist - forgive my not knowing this, but have you looked for an underlying immunilogical issue - we did not find that yet, but if you do, then that will really help as well.

[DawnMCH]

We have Anthm also

We have a diagnosis other than PANDAS too for insurance: something like Immunological Disorder Not otherwise specified.

They only pay for 3 500 mg. or 5 250 mg. per month.

It took months to get Augmentin approved.

We switch companies March 1 - I'm hoping its better and not worse, we're going broke paying for Zith. out of pocket.

-Dawn in Ohio

[memom]

This really fries my you know what. I can understand hesitating with paying for PEX at $40,000 a pop, but antibiotics? They won't hesistate to pay for psych meds which can be very expensive and don't treat the underlying problem.... Don't get me started. I would consider getting antibiotics online with a Canadian pharmacy if I needed to.

 

memom

[dcmom]

Sorry, but I have to interject. We are in the midst of fighting with the insurance co to get my daughter, who is in crisis, pex. Her doctor says it is an emergency and she needs it. The hospital is ready to do it. And some pencil pusher at my insurance co doesn't want to authorize because it is not in AMA guidlines.

 

I have a problem with this!

[Joan Pandas Mom]

I agree. There information is so dated too.

 

I truly feel that if NIMH would get around to updating their very out of date web site this may not be so much of a problem. I feel is is extremely unfortunate for the children that physicians seeking guidance look to the NIMH web site and see that antibiotics are not warranted.

 

Colleen

[Joan Pandas Mom]

That's a good idea. I'll try that with insurance. What is an underlying immunological problem?

[Joan Pandas Mom]

This is so wrong. How can we change this?

 

Sorry, but I have to interject. We are in the midst of fighting with the insurance co to get my daughter, who is in crisis, pex. Her doctor says it is an emergency and she needs it. The hospital is ready to do it. And some pencil pusher at my insurance co doesn't want to authorize because it is not in AMA guidlines.

 

I have a problem with this!