Has anyone had to deal with insurance denial of IVIG? My previous provider had no issues giving me IVIG for the past two years, but my new insurance (Cigna) has denied my IVIG because I'm outside of what they deem as normal for the amount I receive. I'm appealing, but at a loss for what I do next....
I wasn't denied, but the cost (my out of pocket) was terribly high ($1000) per treatment. I did some research and found out that it was also provided through my prescription company, called a Specialty Pharmacy. It is $20 per treatment with them. I can't understand the huge difference in price, but I am not asking. It is approved for me through the end of the year. Might be something for you to look into. I hope you can get things worked out.
Yvonne
Sometimes I really think insurers deny just because some people will not pursue it further and thus they save mega bucks to line their pockets with.
I was denied once, however my doctor wrote them a letter informing them why other treatments plans would not work well in my case and then it was approved. Let your doctor know what happened and perhaps he can send them more information.
Good luck!
I signed on with BCBS of IL the silver plan. I have 5 denial letters for IVIG. But I had previously been approved for a year thru Public Aid. But I am no longer receiving IVIG because I felt it was doing nothing for me. I didn't have any good days and all I wanted to do was sleep. But I've realized it was holding a bad relapse at bay. I requested to go back on IVIG and was told NO. So now I am in such pain that at times I can hardly move. I have had to go back to using my walker because my left leg especially doesn't want to work. So eventho I have IVIG that I could be using, my neuro isn't letting me. So instead I just suffer in pain each day.
I just had my loading dose of IVIG in two weeks I start a weekly treatment plan. I am fortunate to have carpenters fund insurance. It’s all covered no copayment and they have extended my coverage a few more months.
FYI, I have had an employee-sponsored BlueCross/Blue Shield insurance plan for more than 30 years. It is the most expensive plan offered by my employer, so it may be similar to a platinum plan. For more than 15 years, the plan has been covering my IVIG infusions, which I receive at home in New Jersey. Initially, I was reimbursed by New Jersey BlueCross/BlueShield. However, about five years ago, my reimbursements began coming from Florida Blue Cross Blue Shield (the provider of the medicine was located in Florida). One thing that I've noticed is that Florida Blue Cross/Blue Shield was prompter in processing my insurance claims and created less red tape than New Jersey Blue Cross/Blue Shield. However, this year my insurance plan made it economically impossible to continue using the Florida provider (which I used for about 15 years). This year, I need to use the "Specialty Pharmacy Program" contractor, which is CVS Caremark. This costs me $40 for each 30 day supply of IVIG, regardless of how much I use in a 30 day period.
While this information may not be entirely relevant to the platinum plan you are considering, it may give you some ideas to consider.
Please look for a new neuro! I too live in IL and while my daughter will be covered by current docs until she is about 21 we have to start looking for a good adult neuro in the Chicago land area.
Jordan said:
I signed on with BCBS of IL the silver plan. I have 5 denial letters for IVIG. But I had previously been approved for a year thru Public Aid. But I am no longer receiving IVIG because I felt it was doing nothing for me. I didn't have any good days and all I wanted to do was sleep. But I've realized it was holding a bad relapse at bay. I requested to go back on IVIG and was told NO. So now I am in such pain that at times I can hardly move. I have had to go back to using my walker because my left leg especially doesn't want to work. So eventho I have IVIG that I could be using, my neuro isn't letting me. So instead I just suffer in pain each day.
Thank you everyone for your replies. I was able to get my IVIG extended another couple of months until I can get in to see Dr. Lee at Vanderbilt (Center of Excellence). My insurance company is wanting to see me wean down my dose of 120g every three weeks, if possible, and hopefully my new doctor can help find my correct dosage of medication. I just wish insurance wasn't so difficult on top of an already difficult disease.