DawnMCH Posted June 3, 2010 Report Posted June 3, 2010 The insurance company says they cannot send me a comprehensive list of what is covered for what. They need a diagnosis (ICD) code, which I think for us is 279.3 (unspecified immunity deficiency) But what have people been billed under for a treatment code (CPT?) I find 90780 that is for injections of medicine, but I'm betting there are additional codes for the actual medicines. If anyone who has had insurance even partially cover their IVIG, can you look at your bill (pretty please!) and let me know what diagnosis and treatment codes were used? Thank you so much - I'd really like to do this over the summer and start with a fresh and happy new school year! Dawn in Ohio
melanie Posted June 3, 2010 Report Posted June 3, 2010 Hi nDawn Im at work now but when I get home Ill check the box.I just recieved the meds tues so the insurance stuff should be on top. Melanie
EAMom Posted June 3, 2010 Report Posted June 3, 2010 here is an old thread on codes which might help: http://www.latitudes.org/forums/index.php?...art=#entry35553 (But, if you have United Healthcare it's easy, since they cover PANDAS.)
MomWithOCDSon Posted June 3, 2010 Report Posted June 3, 2010 (But, if you have United Healthcare it's easy, since they cover PANDAS.) Apparently, not anymore. At AO conference, Dr. B. confirmed United has ceased to cover IVIG with PANDAS diagnosis, which backed up an experience here on the forum a few weeks ago where someone had it initially approved for payment by United, and then renigged upon in the end. Stinkin' insurance companies . . . . .
bgbarnes Posted June 3, 2010 Report Posted June 3, 2010 (But, if you have United Healthcare it's easy, since they cover PANDAS.) Apparently, not anymore. At AO conference, Dr. B. confirmed United has ceased to cover IVIG with PANDAS diagnosis, which backed up an experience here on the forum a few weeks ago where someone had it initially approved for payment by United, and then renigged upon in the end. Stinkin' insurance companies . . . . . Seriously United Healthcare stopped covering IVIG for PANDAS- crap!! We have not gotten to that yet- but I know we are talking about it next week and was not planning on it being a big issue b/c we have United.... AHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!! Brandy
EAMom Posted June 3, 2010 Report Posted June 3, 2010 (edited) (But, if you have United Healthcare it's easy, since they cover PANDAS.) Apparently, not anymore. At AO conference, Dr. B. confirmed United has ceased to cover IVIG with PANDAS diagnosis, which backed up an experience here on the forum a few weeks ago where someone had it initially approved for payment by United, and then renigged upon in the end. Stinkin' insurance companies . . . . . We had IVIG just last week. hmmmm...I thought we were approved...? I'm pretty sure our facility wouldn't have done it if we weren't. This link (from Nov. 09) says IVIG is proven for PANDAS (pg 13). https://www.unitedhealthcareonline.com/ccmc...n_Sept_2009.pdf Edited June 3, 2010 by EAMom
MomWithOCDSon Posted June 3, 2010 Report Posted June 3, 2010 (But, if you have United Healthcare it's easy, since they cover PANDAS.) Apparently, not anymore. At AO conference, Dr. B. confirmed United has ceased to cover IVIG with PANDAS diagnosis, which backed up an experience here on the forum a few weeks ago where someone had it initially approved for payment by United, and then renigged upon in the end. Stinkin' insurance companies . . . . . We had IVIG just last week. hmmmm...I thought we were approved...? I'm pretty sure our facility wouldn't have done it if we weren't. This link (from Nov. 09) says IVIG is proven for PANDAS (pg 13). https://www.unitedhealthcareonline.com/ccmc...n_Sept_2009.pdf I don't have United, so I'm only reporting what I've been told. But EAMom, were you approved under the PANDAS coding, or some other immune deficiency issue with a different code? If I understood Dr. B. correctly, that is the issue for some.
MomWithOCDSon Posted June 3, 2010 Report Posted June 3, 2010 This is where I got the negative info about United Healthcare's coverage of IVIG: United Healthcare and IVIG Coverage Seems some people get it approved while others don't. EAMom, I love the fact that it's represented right there in their literature! Fabulous! But it seems as though either 1) their benefits personnel don't have a true "company line" on the issue, or 2) there are extenuating circumstances that lead to some IVIG's being covered while others are not. Maybe PANDAS in conjunction with a deficiency? Seems as though Dr. B. might be the one to definitively answer this question, based on the previous thread. Good luck, BQ!
EAMom Posted June 3, 2010 Report Posted June 3, 2010 dh should know more...so maybe he'll chime in. I'm not sure what coding they used this time?
jayjay Posted June 4, 2010 Report Posted June 4, 2010 dh should know more...so maybe he'll chime in. I'm not sure what coding they used this time? I feel like my replies might have been confusing some. We have United Healthcare/Oxford which is different than UHC. We were denied (only the second patient of Dr. B's to be denied) because he had to submit him as autoimmune not immune deficient. If my son was immune deficient he would have been covered. The Oxford plan does not have a PANDAS code and they consider IVIG for autoimmune experimental and investigational. It really varies on what insurance company you have and how your child presents. The Oxford plan really stinks : (
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