Treatment being reduced? CIPD

    • June 29, 2015 at 7:09 am

      Good Morning,

      Anyone ever been told the 5 IVIG treatments that worked the last 5 relapses are now reduced to three? (CIPD PATIENT diagnosed twice once AHN then again by UPMC the insurance is UPMC.)
      A month ago this happened. My friend has been lying in a SNF for a month being told that if she doesn’t progress she will have to go to private pay.

      Yesterday she was admitted to the ER with blood clots in lungs and legs. In ICU after a battle to get the SNF to send her. She is on a heparin drip.

      Seems to be conflicting treatment plans between the UPMC doctor’s and her Nurologist that was treating her with great success prior and continues to want to do so.

      If anyone has herd of anything like this please share.

      Thank you – Lisa

    • June 29, 2015 at 4:38 pm

      Lisa, I will assume you are referring to University of Pittsburg Medical Center (UPMC). They have many insurance plans, some thru the ACA, and some thru Medicare. What coverage plan does your friend have? What are the criteria it uses to authorize IVIg type treatments? SNF stays? Most insurance carriers require that very specific requirements be met in order for them to pre-approve expensive treatments (IVIg) or SNF stays.

      The Perelman School of Medicine at the University of Pennsylvania is a “center of excellence” for treatment of your friend’s condition. Perhaps she would get better care there? However, her insurance may not pay for services there.

      What hospital is her Neuro associated with? She may have to switch to one that is knowledgeable about navigating UPMC criteria.