IVIG retroactively denied

[mom md]

Just heard today that BCBS NC retroactively has denied IVIG. Not sure exactly what that means because they have already written the check for the first but does not sound good. I am planning to get all three doctors that said we needed it to write letters an include the codes (autoimmune not otherwise specified, chorea, autoimmune encephalitis, etc ). I think it is interesting though that they covered PEX and the first IVIG and then just starting dening. It is like a magic number was reached. My guesss is we will go to legal action next if needed. Any helpful hints? (especially since the new neurologist thinks he may need it every 3-6 months if he continues to flare).

[sf_mom]

We used a health care advocate in the past with great success.... more cost effective then attorney. Tried to challenge coverage of our twin pregnancy.

 

http://www.healthcareadvocates.com/president.html

Edited May 4, 2010 by SF Mom

[Iowadawn]

Mom md-

 

I am going to PM you. We have BCBS in Iowa. We have been successful--this last time with the help of some info to include from Dr. K. We are lucky that we had the benefits person at dh work use the work's insurance rep, who rattled cages at BCBS and within 24 hrs our final appeal was reversed and we were approved for any additional IVIG's we would need until Oct (year mark of the first one). I will PM you.

 

Dawn

[Doug]

We are still waiting for BCBS to make up there mind and it has been almost 3 months since our first IVIG with Dr k

BUT our daughter is doing great and that is what is most important...

Tracie

[Suzan]

Just heard today that BCBS NC retroactively has denied IVIG. Not sure exactly what that means because they have already written the check for the first but does not sound good. I am planning to get all three doctors that said we needed it to write letters an include the codes (autoimmune not otherwise specified, chorea, autoimmune encephalitis, etc ). I think it is interesting though that they covered PEX and the first IVIG and then just starting dening. It is like a magic number was reached. My guesss is we will go to legal action next if needed. Any helpful hints? (especially since the new neurologist thinks he may need it every 3-6 months if he continues to flare).

 

Oh bad news. This is what I am afraid of to with UHC. Good luck and let us know how it goes. Is the new neurologist DR. C or did you get in with the other one.... Dr....? I forgot who.

 

 

Susan

[mom md]

We saw Dr. Tess Nelson who was great. We are seeing Dr. C Thursday aso maybe he can help too. I will keep you posted.

Just heard today that BCBS NC retroactively has denied IVIG. Not sure exactly what that means because they have already written the check for the first but does not sound good. I am planning to get all three doctors that said we needed it to write letters an include the codes (autoimmune not otherwise specified, chorea, autoimmune encephalitis, etc ). I think it is interesting though that they covered PEX and the first IVIG and then just starting dening. It is like a magic number was reached. My guesss is we will go to legal action next if needed. Any helpful hints? (especially since the new neurologist thinks he may need it every 3-6 months if he continues to flare).

 

Oh bad news. This is what I am afraid of to with UHC. Good luck and let us know how it goes. Is the new neurologist DR. C or did you get in with the other one.... Dr....? I forgot who.

 

 

Susan

[dcmom]

MomMD,

 

We had the SAME thing happen with pex- but it was in the end covered.

 

We ended up going through three levels of appeals. We enlisted the help of the HR person at husband's company who dealt with the insurance company. I called the insurance co every day. And we had our doctor send some studies, and write a letter along with medical records that stated that the insurance company was putting our daughter's health in jeopardy by delaying treatment.

 

They took their own sweet time, and went through their slow as molasses process. But we were approved.

 

I hope this is what happens for you....

[MMC]

Sorry to hear this, Mom MD. We also have BCBS of NC as you know and they covered our first IVIG 3 weeks ago, (as well as PEX back in Jan). We will be scheduling a second one soon through Dr C at CMC-Northeast. Will see what happens. I'm hoping the immune deficiency our son has will be an acceptable code for them. PM me if you learn any tricks with BCBSNC... hope it all works out for you.

[tpotter]

Write a letter to your state insurance commission with all supporting documentation. The 2 times I have had a serious problem with our insurance company denying something that shouldn't have been denied, I wrote a letter to the State Insurance commission (happened to be in 2 different states, and nothing to do with PANDAS) and as soon as the insurance company heard from them, they (the insurance company) called me, and said something like: "You will be very pleased to know that we have changed our mind!"

 

Let me know if it works, because we are still needing to do IVIG on both our boys, and we have BCBS, as well (haven't started the insurance process yet, though.)

[JAG10]

GREAT suggestion

 

Wayne's your guy!

 

http://www.ncdoi.com/commissioner.asp

[melanie]

Write a letter to your state insurance commission with all supporting documentation. The 2 times I have had a serious problem with our insurance company denying something that shouldn't have been denied, I wrote a letter to the State Insurance commission (happened to be in 2 different states, and nothing to do with PANDAS) and as soon as the insurance company heard from them, they (the insurance company) called me, and said something like: "You will be very pleased to know that we have changed our mind!"

 

Let me know if it works, because we are still needing to do IVIG on both our boys, and we have BCBS, as well (haven't started the insurance process yet, though.)

 

 

Hi

 

I also have BCBSNJ I fought with them for about a month and finally reached a rep who was a senior pediatric specialist (her name is Liz)It was December 23rd 2009 I remember because I was getting my nails done and my cell rang she told me everything went through and to schedule the IVIG .I cried ,and hes been recieving the treatments at home every 21 days since January 2010.We do the IVs through optioncare (walgreens ) and they come here and it has worked great.The first one was in the hospital but since then here.I think that helped them its cheaper to do it at home so they may have been more likely to accept that.

 

Melanie