Insurance company and IVIG

[memom]

I know I am probably being impatient but......what has been the range of time other's have noticed from the time the physician's office (Dr. B. in particular) tries to get precertification for IVIG and the go ahead? I have been waiting for what seems like ages (3+ weeks now) and as each day passes, I am preparing myself for rejection.

Any thoughts?

 

Ellie

[Suzan]

I have the opposite issue. My insurance company says I don't need preauthorization. I should be jumping for joy but I just feel like it's too good to be true but our plan does say IVIG covered for PANDAS.

 

Have you tried to call the doc's office to see what they have heard? My doc's office didn't call to tell me everything was set. I had to call them and ask.

 

Susan

[memom]

Not yet but will do so. Do you mind telling me what insurance you have?

 

Ellie

[Suzan]

Not yet but will do so. Do you mind telling me what insurance you have?

 

Ellie

 

I have UnitedHealthCare. I'll be sure to report back on whether it goes through without a hitch. I'm still worried about it. We leave in an hour for our first treatment!

 

Susan

[memom]

I wish you well today and for the next several months. Keep us posted.

 

Ellie

[peglem]

Not yet but will do so. Do you mind telling me what insurance you have?

 

Ellie

 

I have UnitedHealthCare. I'll be sure to report back on whether it goes through without a hitch. I'm still worried about it. We leave in an hour for our first treatment!

 

Susan

Much as I hate to praise an insurance company- UHC has paid for the 2 IVIGs that my daughter has gotten and they also gave me a gap exception for our Dr.L visit in January. We only had to do the $35.00 specialist copay. (Well and the cost of 4 airline tickets and a week's hotel stay and rental car....But, still)

I don't know if they required pre-approval for the IVIGs- immuno's office dealt with all that.

[fuelforall]

Susan, I think you have to get pre certification anyway. Don't wait for trouble to hit you later. I have UHC and I got pre-cert to make sure.

(I know, you just left)

[Suzan]

Susan, I think you have to get pre certification anyway. Don't wait for trouble to hit you later. I have UHC and I got pre-cert to make sure.

(I know, you just left)

 

I did decide I better call so while we were getting set up, I called the insurance company. They confirmed that I did not need pre-approval. Still, I find it hard to believe but they said 80% covered.

[memom]

I'm jealous. I have a sneaking thought we may get denied. No immune deficiency. Not an extreme case anymore. Just not at 100%. I would say we are at about 70%normal since tonsils out, steroids for 2 months since November, and antibiotics (have done 4 different prescriptions). I just know that she will never get to normal unless we try IVIG. We have also done a full year of weekly CBT, and SSRI's (very high doses). She is barely going to be graduating from High School, no chances for College given such bad grades since her major flare 2 years ago. I am not sure how she will ever be able to live independently.

 

Ellie

[Stephanie2]

I'm sure you already thought of this, but can she go to community college for 2 years? My parents had a very ugly divorce while I was in high school, I ended up living in 3 different states for high school. I did not graduate with the best GPA so I went to CC for one year and then applied to the school of my choice and got in! May not be what you/she had planned, but I graduated with honors from college and landed the best paying job of all my friends (that career is long gone now!!). Just focus on getting her well and the rest will fall into place.

 

Stephanie

 

I'm jealous. I have a sneaking thought we may get denied. No immune deficiency. Not an extreme case anymore. Just not at 100%. I would say we are at about 70%normal since tonsils out, steroids for 2 months since November, and antibiotics (have done 4 different prescriptions). I just know that she will never get to normal unless we try IVIG. We have also done a full year of weekly CBT, and SSRI's (very high doses). She is barely going to be graduating from High School, no chances for College given such bad grades since her major flare 2 years ago. I am not sure how she will ever be able to live independently.

 

Ellie

Edited April 29, 2010 by Stephanie2

[Mary M]

I'm jealous. I have a sneaking thought we may get denied. No immune deficiency. Not an extreme case anymore. Just not at 100%. I would say we are at about 70%normal since tonsils out, steroids for 2 months since November, and antibiotics (have done 4 different prescriptions). I just know that she will never get to normal unless we try IVIG. We have also done a full year of weekly CBT, and SSRI's (very high doses). She is barely going to be graduating from High School, no chances for College given such bad grades since her major flare 2 years ago. I am not sure how she will ever be able to live independently.

 

Ellie

 

 

I am so sorry for you and your daughter. After our difficult day today...I worry for my daughter's future as well. None of us should ever have had to experience what we are living with. I hope your IVIG is approved.

[fuelforall]

I did decide I better call so while we were getting set up, I called the insurance company. They confirmed that I did not need pre-approval. Still, I find it hard to believe but they said 80% covered.

 

80 percent? Is your IVIG person out of network? Must be, because it should be 100%. Are you going to Dr. B, I thought you were in the East Coast, maybe not. Call UHC and ask them who in their network does IVIG and is 100% covered.

Dr B was, fortunately. So it's a $25 copay. What a deal.