saidie10 Posted July 17, 2010 Report Posted July 17, 2010 Just wondering if anyone was successful in getting coverage for IVIG for PANDAS under Blue Cross Blue Shield of Texas?
lss Posted July 17, 2010 Report Posted July 17, 2010 Because of his immune deficiency, the doctor should not be using Pandas as the reason for treatment, but he should be using the codes for enceph. other
saidie10 Posted July 17, 2010 Author Report Posted July 17, 2010 I know that the Immune Deficiency should get him coverage but this Doctor said we will put PANDAS as that is what we want to get coverage for...that is what we are treating. He is very "ethical" and I don't know if he is going to budge on that! I am afraid we risk not getting coverage because of that!
peglem Posted July 17, 2010 Report Posted July 17, 2010 I know that the Immune Deficiency should get him coverage but this Doctor said we will put PANDAS as that is what we want to get coverage for...that is what we are treating. He is very "ethical" and I don't know if he is going to budge on that! I am afraid we risk not getting coverage because of that! Okay, but, PANDAS is a kind of autoimmune encephalitis, or post infectious autoimmune encephalitis. It just seems like insurance is looking for a way to not cover.
lss Posted July 17, 2010 Report Posted July 17, 2010 He can still put Pandas down, but he ethically still should explain to the insurance company about his immune deficiency as well. Dr. K also rights a letter to insurance co.
saidie10 Posted July 17, 2010 Author Report Posted July 17, 2010 He can still put Pandas down, but he ethically still should explain to the insurance company about his immune deficiency as well. Dr. K also rights a letter to insurance co. thanks for the replies guys. i am going to the call the doctors case worker on Monday who handles all the pre-approvals. i will also talk to one of his charge nurses to discuss my concerns over this...since i know i can't get the doctor on the phone!!! anyway, some other ladies on the board are going to give me the cpt codes that dr. k and another doctor in dallas used and both used PANDAS but also used what you guys are talking about I guess when it comes to autoimmune disorder/immune deficiency, and or infectious encephalopathy. so i guess we will see!!!!!
mdmom Posted March 2, 2011 Report Posted March 2, 2011 Hello, I just found your post and was wondering if you ever did get BCBS to cover IVIG using the PANDAS diagnosis. I have BCBS and they just denied my son's IVIG for PANDAS; doctor used this dx even though he usually uses an immune deficiency dx. Our case is now being appealed, but I am not hopeful. Any help you can give me is much appreciated. Thank you.
NVAmom Posted March 2, 2011 Report Posted March 2, 2011 We have not pursued IVIG. However, our dr said PANDAS is a clinical description of symptoms- not a diagnosis for coding. According to our dr the codeable diagnosis is Post infectious Encephalitis after Streptococcus. Hope that helps.
mdmom Posted March 2, 2011 Report Posted March 2, 2011 We have not pursued IVIG. However, our dr said PANDAS is a clinical description of symptoms- not a diagnosis for coding. According to our dr the codeable diagnosis is Post infectious Encephalitis after Streptococcus. Hope that helps. Thanks for the information. I believe as of 1/1/11 there is now a code for PANDAS. It's in the newest ICD-9 book.
butterflymom Posted March 2, 2011 Report Posted March 2, 2011 (edited) = Edited February 3, 2016 by butterflymom
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