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» LymeNet Flash » Questions and Discussion » Medical Questions » how to get ivig covered

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Author Topic: how to get ivig covered
katrinab
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I'm having a difficult time trying to find out how I can get this is ivig treatment covered. I call the doctor in Connecticut the only doctor that I know of nearby that can prescribe it and I live in Massachusetts and his secretary was not helpful at all about telling me what I would need to show the insurance company that I have an autoimmune condition. the only test that I have now is a positive an Ana but i dont know if there's more tests that can be done to determine if I have an autoimmune condition. I have masshealth bmc insurance. does anyone know what i would I need
Posts: 723 | From boston,ma | Registered: Jan 2011  |  IP: Logged | Report this post to a Moderator
GretaM
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Not sure about adults but for kids that have low lymphocytes, IVIG is a treatment option offered.

Have you had your immunoglobbin (IgA IgG IgM) measured?

Sometimes if those numbers are out I have heard of folks getting IVIG.

Posts: 4358 | From British Columbia, Canada | Registered: Jun 2013  |  IP: Logged | Report this post to a Moderator
Sammi
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You should be evaluated by an immunologist and have your immune function levels tested. Often if those are off, further testing is done.

IVIG is extremely expensive (thousands per dose). Your labs need to justify a deficiency in order to get it covered.

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Rumigirl
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I sent you a PM.

One of the common things that gets it covered, is if you have a punch skin biopsy done, and it shows that you have Peripheral Neuropathy. Many people with Lyme have that without knowing it.

I recommend it.

The protocol for neuropathy is a higher dose and frequency than for immune deficiencies. Some people have both, but in that case, you'd be better off with the higher dose and frequency.

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smiles132002
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I was on IVIG for 2 years and it helped me so much. Out of no where my insurance denied me and I've spent the last two years trying to get it back. It's very frustrating. While my immune levels were never low enough to qualify, I knew, we knew it was only a matter of time before I would. Last december my immune function dropped low enough to qualify for IVIG. It's still taken me 6 months to go through the approval process. I am now waiting on home health finding nursing. I am sad it had to get to this point to get treatment because I was doing so well and now I am set back..
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Sammi
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smiles13200, I am very sorry you went through this with your insurance company. It is terrible! From what I understand, IVIG is for life. Insurance reps should know this.

I am glad you have been reapproved. I hope you don't have to go through this again.

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Splashi1
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Rumi girl,

I am having the same problems with getting it covered. If you have any helpful info that you'd care to share, via PM, that would be much appreciated.

Thanks!

Posts: 141 | From East Coast USA | Registered: Sep 2010  |  IP: Logged | Report this post to a Moderator
Littlesprout
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I would call your ins company and see what conditions they cover for IVIG. Demyelination is one, MS, low Ig levels.
Find what they cover and try to go in that direction.

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jennyfromtheblock
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I had trouble getting it covered. It was prescribed back in Feb.

It should have been covered. I have low igg subclasses, a history of bacterial skin infections, multiple sinus infections not cured by one course of abx. I made sure I had documentation of all of this(I also have a high ANA (1280).

I switched insurance co's and my labs were redrawn, levels lower than ever. They called yesterday and it was approved!

However, I am getting Hyzentra, a Sub Q Igg. The dr. who prescribed it is not an immunologist. I have seen an immunologist, it was a waste of my time. She messed up my testing and made be even sicker by giving me the pneumonia vaccine.

Good luck

--------------------
celiac dx 2012
pancreatic neuroendocrine tumor dx 2012
lyme dx 2/14
poss igm wb, neg igg wb - Igenex/CDC

Posts: 85 | From south shore | Registered: May 2014  |  IP: Logged | Report this post to a Moderator
   

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