PPH in patient or Outpatient?

    • Anonymous
      March 22, 2011 at 3:20 pm

      It’s been awhile since I posted, but I’ve been reading all along. I need advice from all of you, (the real experts).
      I was diagnosed with CIDP in Nov. 2008 and then assigned (thru my HMO) to a neuro, who decided that maintaining me was more important than treating me. So two years, or so, later, and with symptoms getting worse… I was able to get the head of the neuro group to work me up and he CONFIRMED, the CIDP diagnosis thru an independent EMG.

      I Was treated in ’08 & ’09 with IVIG, sumedrole (sp)? And steroid tablets, none of which helped me. The head of the group now, has offered PPH as a next course of treatment which I have agreed to. Here is the question. My new Dr. wants to run 5 passes of PPH over 7 days with me in the hospital.
      My HMO wants it to be as an “outpatient”. This concerns me. Everything I’ve read is emphatic as to the initial load being administered as an inpatient.
      What do all of you think? Should I relax and go along with Outpatient, or get vocal and challenge the HMO for Inpatient,???

    • Anonymous
      March 22, 2011 at 3:47 pm

      My vote is to challenge them. Do your research, enlist your physician’s help. Get copies of the literature supporting your position and present that to the HMO, or have your doctor do it. Complain to your state insurance department. All the HMO can do is say no, and you won’t be any worse off. Keep in mind that the vast majority of individuals who challenge insurers are successful. Make some noise. Let them know that what you are being asked to accept is neither reasonable nor safe. If they still refuse, let them know in writing that you intend to hold them responsible if anything goes wrong. Let us know how it turns out.

    • Anonymous
      March 22, 2011 at 5:33 pm

      I think your dr can contact your insurance company & request they approve you for inpatient treatment.

      You can also contact the hospital & ask for the patient advocate on staff to help you deal with your insurance company.

      Good luck,

    • Anonymous
      March 22, 2011 at 9:27 pm

      When I had mine it was done all out patient in the infusion ward. It really did not take that long compared to the long ivig sessions. I had great results but could not tolerate the central lines.

    • Anonymous
      March 23, 2011 at 4:47 am

      I am assuming you are referring to plasma exchange? I had 17 of these treatments back in 2002, the first 5 while I was inpatient & the other 12 as outpatient. They can be grueling, but usually don’t last for more than a few hours. My worst problem was my blood pressure dropping dramatically toward the end. They were stopped for me, as they didn’t help me at all. I was also on solumedrol infusions for 21 months; helped very little. If one doesn’t respond well to IVIG, usually PE won’t help much either. That is why I resorted to the cyoxan infusions in 2003 to arrest my CIDP.

    • Anonymous
      March 24, 2011 at 12:38 am

      [COLOR=black]All of my plasmapheresis treatments have been done on an outpatient basis, with no problems of any serious note. I often (about half the time) experienced a large blood pressure drop towards the end of the treatment. If it happened, I would just take it easy, eat something salty, drink some juice, and wait until my blood pressure was up. Only rarely did the recovery take more than a few minutes. [/COLOR][COLOR=black][/COLOR]
      [COLOR=black] [/COLOR]
      [COLOR=black]I could have insisted on having the initial treatments done in-patient, but I did not see a need for it. I knew that the dialysis nurses had considerable experience with the procedure and knew how to handle an emergency. However, my treatments were done in a large medical center, where plasmapheresis was done daily.[/COLOR][COLOR=black][/COLOR]
      [COLOR=black] [/COLOR]
      [COLOR=black]Just my experience.[/COLOR][COLOR=black][/COLOR]
      [COLOR=black] [/COLOR]
      [COLOR=black]Godspeed in your decision,[/COLOR][COLOR=black][/COLOR]

    • Anonymous
      April 4, 2011 at 5:08 pm

      Thank you all for your input…

      I feel much more comfortable with considering “out patient” treatment.
      I have an appointment Thursday, at the hospital, to see one more Doc.
      and to shcedule it.

      Thanks again, JJM (Jeff )

    • Anonymous
      April 4, 2011 at 9:36 pm

      There is nothing wrong with outpatient, except that the cental line is surgery and maybe an overnight stay would be in order for that. If the hospital you are going to has the machine, outpatient is fine. My daughter has been receiving PE since July 2008, we are now at one every 4 weeks. She did not respond to IVIG. As long as you can drive or someone can take you outpatient is good, the problem here is that my daughter cannot drive and it takes a lot of my time. The actual procedure including setting up the machine is about 2 1/2 hours. Her blood pressure drops but it comes back when the procedure is finished.

    • Anonymous
      April 4, 2011 at 11:36 pm

      that first time in-patient? It’s got to be HIS fight to get you there that way.
      As Nicsmom said? Key to this all is your ability to get to and fro after the procedure and back the next day! Don’t forget? Plasmapheresis IS an invasive procedure and it can cause many reactions that could require IN-Patient monitoring… call your insurance and ask to speak to an EXPERT in this particular area? Find out if your doc needs to be more articulate about why he considers this need for in-patient treatment? OR, if the insurance will guarantee admittance should anything go wrong! Then ask them to either fax or e-mail both you and your doc to that effect. That way? You’ve got yourself protected, as has the prescribing docs. That’s why docs have staff!
      Soo, let the docs and the insurance fight it out? Then decide IF it’s safe for you…but ask lots of questions from both your docs AND your insurance company! The latter likely wants to save a few $’s. But do you want to put your life on the line for those $’s? You don’t want to find expensive surprises 3-5 months down the road.
      With many HMO’s it’s a danged if you do? or, don’t issue! Face it? We cost too much? Treatment wise that is. I truly wish it weren’t so. Originally, HMO’s were created to avoid just this sort of issue! Ironically the bean counters got involved… Sigh.
      I truly hope you get relief and some soon! Without hassle or problems. Nothing like insurance wrinkles to add a little stress to your life!

    • Anonymous
      April 5, 2011 at 9:18 pm


      Just to elaborate, I had a central line put in with local anesthesia (lidocaine), had my first treatment about an hour after, then went home. Other than a bad case of blood pressure drop, more accurately orthostatic hypotension, it was not a big deal. I think the OH was as much a result of fasting all day (surgery requirement) as it was the procedure. I should have eaten something before I left the dialysis unit.

      Godspeed in your treatment,