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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!

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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.

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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!!!!!

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  • 7 months later...

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.

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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.

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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.

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