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IVIG approved by our insurance company


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Dr. Bouboulis got IVIG covereage for us through United Healthcare. He found a selective immune deficiency (if I understand correctly) and she will get ivig within a months time if everything goes as planned. I just wanted to share our good news. Good news seems to be rare on this forum. We're hanging in there. The most recent prednisone taper is beginning to work again. I hope it lasts until we can get the ivig.

 

Wishing everyone good health,

Angela

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That's great news and interesting to me, because Aetna denied IVIG for me because my deficiency was "only" selective. Maybe we'll switch to UHC next time around... I've heard from the primary immune boards that they are one of the better ones for coverage for immune issues. I'm just afraid to make any kind of switch now that Aetna has approved such generous coverage for the boys...

 

Best of luck!

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Take a look at page 13 :

https://www.unitedhealthcareonline.com/ccmc...n_Sept_2009.pdf

 

Buster

 

Dr. Bouboulis got IVIG covereage for us through United Healthcare. He found a selective immune deficiency (if I understand correctly) and she will get ivig within a months time if everything goes as planned. I just wanted to share our good news. Good news seems to be rare on this forum. We're hanging in there. The most recent prednisone taper is beginning to work again. I hope it lasts until we can get the ivig.

 

Wishing everyone good health,

Angela

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Take a look at page 13 :

https://www.unitedhealthcareonline.com/ccmc...n_Sept_2009.pdf

 

Buster

 

Dr. Bouboulis got IVIG covereage for us through United Healthcare. He found a selective immune deficiency (if I understand correctly) and she will get ivig within a months time if everything goes as planned. I just wanted to share our good news. Good news seems to be rare on this forum. We're hanging in there. The most recent prednisone taper is beginning to work again. I hope it lasts until we can get the ivig.

 

Wishing everyone good health,

Angela

Thanks, Buster. It would be interesting to know the politics of why UHC is more willing to cover treatment for PANDAS (or even recognize PANDAS as a real disorder) than other companies. Also, interesting- my daughter has secondary insurance through the state, which is contracted out to a subsidiary of UHC. The subsidiary has denied claims that the parent company covers.

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Take a look at page 13 :

https://www.unitedhealthcareonline.com/ccmc...n_Sept_2009.pdf

 

Buster

 

Dr. Bouboulis got IVIG covereage for us through United Healthcare. He found a selective immune deficiency (if I understand correctly) and she will get ivig within a months time if everything goes as planned. I just wanted to share our good news. Good news seems to be rare on this forum. We're hanging in there. The most recent prednisone taper is beginning to work again. I hope it lasts until we can get the ivig.

 

Wishing everyone good health,

Angela

Thanks, Buster. It would be interesting to know the politics of why UHC is more willing to cover treatment for PANDAS (or even recognize PANDAS as a real disorder) than other companies. Also, interesting- my daughter has secondary insurance through the state, which is contracted out to a subsidiary of UHC. The subsidiary has denied claims that the parent company covers.

We have UHC/Oxford. They do not cover IVIG. It doesn't make sence that a parent company will cover, but a subsidary won't, but not much in the insurance world makes sence to me. We have appealed twice and we are waiting for our third denial so we can take it to the CT. Insurance Commission. As we continue the fight, my son will be getting IVIG with Dr. B. tomorrow. I will have my $8,000.00 check in my hand that we robbed our 401K to get. Momaine, I am truly happy for you and all the other parents on here that have that one less battle to fight with this horrifing disorder. You are very lucky that you can consentrate on getting your child well, instead of preparing mountains of paperwork and spending countless hours on the phone with rude people that don't understand or really care. I'm sorry, I didn't mean to be a "downer" on this great news thread. We are blessed that my son will finally be getting the treatment he needs. Let the healing begin...

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Jayjay-

 

I totally understand where you are.

 

We went to the hospital $25K in hand (thanks, Dad!) to get PEX for my daughter, as we couldn't wait for the insurance company to go through their appeals process- she was in crisis. The good news is- in the end they approved it (after dd was home and recovering for a week).

 

Well the insurance co reimbursed us the contracted rate of $5K, so now I am trying to get the $20k back from the hospital....Have to get of the net and go call them again.

 

I have to say, having to fight with the insurance co, and figure out where to get the cash- DOUBLED the agony of having a sick child. Instead of being able to focus 100% on her, her sister, and keeping myself from going insane- both dh and I had to spend hours on the phone with insurance co and doctor.

 

Needless to say- it has left me pretty angry (and I am usually not an angry and bitter person).

 

But- you are totally doing the right thing. Your child will be in recovery by the time the insurance co gets it figured out.

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I see I have a lot of questions to answer. I don't know why I didn't get an email update. I'll have to check my settings.

 

Dr. B told us that juts because UHC has PANDAS listed as a reason to use IVIG doesn't mean that they will cover it. And honestly, I'm only guessing that it was covered for us because of a selective immune deficiency, based on my own interpretation of the test results. I'm haven't actually talked to the dr. himself. The office staff called and told me it was approved but did not tell me why.

 

My dd has been on a tapering dose of prednisone twice now. It began with 40mg for 6 days, then 30mg for 5 days, and then 20, then ten....it was a total of 20 days. Today, day 13, was the best day so far.

 

A selective immune deficiency, in our case, if I am reading the tests correctly, means that my dd cannot fight off a strep infection. Her immune system does not mount the proper response, therefore, the infection lingers even while on antibiotics.

 

Thanks for all the well wishes.

 

Angela

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We have UHC/Oxford and they have covered both PEX through Dr. Latimer and ongoing IVIG with Dr. Bouboulis. We have not paid anything.

I feel so lucky and grateful about this, because I would not be able to pay for these treatments for my kid.

Dr. Bouboulis seems to have a particular knack for getting insurance to cover. See him if you can.

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I see I have a lot of questions to answer. I don't know why I didn't get an email update. I'll have to check my settings.

 

Dr. B told us that juts because UHC has PANDAS listed as a reason to use IVIG doesn't mean that they will cover it. And honestly, I'm only guessing that it was covered for us because of a selective immune deficiency, based on my own interpretation of the test results. I'm haven't actually talked to the dr. himself. The office staff called and told me it was approved but did not tell me why.

 

My dd has been on a tapering dose of prednisone twice now. It began with 40mg for 6 days, then 30mg for 5 days, and then 20, then ten....it was a total of 20 days. Today, day 13, was the best day so far.

 

A selective immune deficiency, in our case, if I am reading the tests correctly, means that my dd cannot fight off a strep infection. Her immune system does not mount the proper response, therefore, the infection lingers even while on antibiotics.

 

Thanks for all the well wishes.

 

Angela

Angela, I'm sure you are covered if the staff called and told you that you were. I'm guessing that my son's case was entered under a different code. They denied saying that IVIG was "expierimental and investigational" None of it makes sence to me. We will just appeal until the end. What matters is my son will be gettting IVIG today and tomorrow and I will worry about the $$$ later. Good luck with your daughter, maybe we will run into you at Dr. B's sometime!

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