What codes are used to approve IVIG?

[tpotter]

We have our 2nd level appeal on Thursday, as you all know we were denied approval for IVIG last week. BCBS is denying based on "experimental" use, and of course, the way the NIMH website has PANDAS listed, it says that we should only be using SSRI and CBT to treat the symptoms (so that sure doesn't help.)

 

BCBS said that we have to show 2 published papers showing the efficacy of IVIG in PANDAS to use it off-label, and so far, I have only found the Lancet article.

 

The doctor coded it as Post-Infectious Encephalopothy, and although he had IVIG before (admitted through the ER via Dr. L), they said they did not officially "approve" it at that time, so they don't have to automatically approve it this time.

 

HELP. Any and all suggestions would be very welcome. I reported the insurance company to the Insurance Commission, and for the first time, it appears to not be working.

 

Is it possible to go back (after the fact), and have the doctor resubmit as auto-immune disorder? If so, what basis is that done under? My son has low IgA (about 35), which is not immunodeficient, but based on one of the doctor's speeches at the OC conference, it does leave him at higher risk for getting infections.

 

Does anyone know what the results of the meeting at NIH?

 

Thanks.

[Chemar]

Hi

 

you posted this on the TS/tics board so I have moved it here for you