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I think insurance paid for IVIG!


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We have UHC (stayed with them and are paying Cobra level payments even though my husband has a new job because as of earlier this year they claimed to be paying IVIG for PANDAS) and were worried when earlier this summer people started having problems getting IVIG coverage with them. We did IVIG with Dr. K August 6/7. We were told that the procedure codes he gave flagged a need for precertification, but of course, UHC didn't get it done in time, so we paid upfront and went ahead with it.

 

Been checking the ins. co's website every day recently. And just today it showed up--it looks like they actually paid! Dr. K and the surgical center are both out of network, so it is 80% coverage after deductible is met

 

The codes used were:

279.9 Unspecified disorder of immune mechanism

348.30 Encephalopathy, unspecified

348.39 NEC Other encephalopathy

 

I won't believe it until I get paper statements from them and have refund checks in hand, but WOOOOOOO!!!!!!!!!!!

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We have UHC (stayed with them and are paying Cobra level payments even though my husband has a new job because as of earlier this year they claimed to be paying IVIG for PANDAS) and were worried when earlier this summer people started having problems getting IVIG coverage with them. We did IVIG with Dr. K August 6/7. We were told that the procedure codes he gave flagged a need for precertification, but of course, UHC didn't get it done in time, so we paid upfront and went ahead with it.

 

Been checking the ins. co's website every day recently. And just today it showed up--it looks like they actually paid! Dr. K and the surgical center are both out of network, so it is 80% coverage after deductible is met

 

The codes used were:

279.9 Unspecified disorder of immune mechanism

348.30 Encephalopathy, unspecified

348.39 NEC Other encephalopathy

 

I won't believe it until I get paper statements from them and have refund checks in hand, but WOOOOOOO!!!!!!!!!!!

 

Congratulations! I hope the paper statements come soon!!.... and I hope your child is doing well!!

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Is it ok for me to be green with envy? We are still doing battle with Aetna 5 months after starting the pre-cert...We are waiting for January for my dh to have open enrollment and switch to UHC in case we need another IVIG (which is looking more and more likely these days). Thanks so much for sharing the codes - I will pass those on to our doc for certain!

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