Insurance coverage on IVIG & Plasmapheresis

Hi Chris,
Now that you mention it…I’m currently in review with my insurance after they denied my IVIG after 7 months at $42,000.00. I had thought it was covered the whole time but I misread my statement (silly me) when it said my balance was “0”. The first month, all they meant was they were going to try my secondary insurance and they never sent another bill till 7 months later. I kept asking the infusion center and they kept saying “sure honey, this stuff is so expensive if your insurance wasn’t covering it we couldn’t treat you.” My doctors office set up the first treatments and I wasn’t even allowed to make the appointments but when it became a mess they all asked me “didn’t you get an approval?” Now I have a really good attorney who I haven’t had to use just yet, we are waiting to see what the review board determines. I had a diagnosis letter from my neurologist along with my EMG tests and nerve conductor tests showing CIDP and IVIG a necessity not experimental. Hopefully they will agree. Take Care, Good luck to you! (and Me!)

Joyce

We haven’t had any trouble with our insurance covering treatments for our daughter (fingers crossed & knocking on wood!) . Last summer her treatments ranged between $20,000 and $25,000 a MONTH!

The infusion center should have someone in the billing department that dealt with your insurance company. It’s BS that they billed you 7 months later. The infusion center doesn’t wait 7 months to send in their bills. They were billing your insurance company every month and if they weren’t getting paid then they should have told you.

I have confidence that your treatments will get covered. Insurance companies don’t like to pay out money & they will fight you in it sometimes. But that’s what the insurance is for & you will win in the end.

Good luck.
Kelly

I have had both IVIG and Plasmaphoresis and both were covered. I even had to switch insurances during this period as my short term disability ran out so we went to hubby’s insurance. So you get a “yeah it was covered” from me. Good luck. Insurance issues are a pain. 🙁

My PP was covered. However the insurance co and hospital bickered back and forth for about 9 months b/c insurance wanted to pay ALOT less than the hospital bill. 5 PP treatments were billed in the amt of $25,100.00.

Chris, it might just be a problem with the coding. If there is a number wrong or missing for the dx code, the insurance won’t pay until it is straightened out to their satisfaction. Look into the bills and get itemized statements for everything, you might want to hire a specialist to lok over the statements. Take care.

We had three prior ivig’s and all of a sudden the insurance decidied for the fourth they needed a letter of medical necessity. Once the letter was sent, the ivig was approved. Try to relax DAwn Keveies mom 😮

Chris,

I have Medicade/Medicare and both are covered with no issues whatsoever, it would seem that the insurance company would follow suit. Neither IVIG or PP are experimental for GBS/CIDP. If you need documentation I can help, just let me know. It is probably in the coding, call your Neuro’s office and ask for help. Or you can call the billing dept. at your hospital. I am going on 4 years of this and I still have issues with almost every bill. Good luck.

Jerimy

That’s what we are here for 🙂

Like Jerimy I have Medicare and never had a problem getting IVIG covered. My secondary insurance has been paying the balance (after $1000 deductible) no questions asked. I’ve been getting IVIG for almost 2 years now.

We had similar issues. Our insurance denied everything at first and requested further documentation from each doctor. It took a long time… months and months. They did a pre-existing investigation which also took a long time…. but they ended up covering things for the most part. They didn’t cover the outpatient treatment at the in-network rate because they said they didn’t get a referral, but we are fighting that with the medical review board of the insurance company. We obtained a letter of medical necessity from the specialist giving the treatment and submitted it. I’ve learned that one step at a time, immediate follow-up, and lots of phone calls to the insurance company and billing offices gets results!

Last month we received a bill ($2,200) for treatment that occurred 15 months ago. How weird is that? Even that one was taken care of with a few (well ok, many, phone calls).

It will be taken care of over time. So don’t worry…. just be your own advocate. Remember, worrying does not empty tomorrow of it’s troubles… it empties today of it’s strength.