Topic: Oxford suddenly took away authorization for IVIG. They're demanding spinal tap & EMG.
Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
I put some of this in my other post, but it got lost in the shuffle. This was the straw that broke the camel's back on top of everything else.
I have been receiving IVIG since August '10 (with some treatment breaks) for Chronic Inflammatory Demylenating Polyneuropathy, which is as a result of Lyme and company. In punch skin biopsies in '10 and '11, it showed markedly reduced nerve fibers. In fact, it got a lot worse between '10 and '11. Plus, I have pretty much zero reflexes, and multiple symptoms over decades.
Each time my doctor changes the orders, due to changing the dose, due to weight loss or due to Oxford's cutting my home-nursing visits from 60 to 40 per year, etc., Oxford has TAKEN AWAY one to several months of authorization that they had previously given!
This time, although I had been authorized through January 31, they waited until December 27th to send out a letter demanding more documentation from the doctor, even though he just gave more documentation. And I was told by the doctor's office that Oxford is requiring that I have a spinal tap and EMG to reevaluate.
I am not going to do that. And my dr said that it is unlikely that either test would show anything. (I've had many pathological EMG's in the past, but they are looking for something else, I think). Also, my doctor should write a letter on my behalf, but is not going to. I have to fight it on my own.
I have to call and speak to a nurse Case Manager to try and fight this. In the meantime, I have NO treatment now at all of any kind. I'm running into constant roadblocks and people not doing their job. I've had it! Oxford hasn't even formally denied me, so I can't appeal at this point! That's a new trick.
I am usually very proactive, but I have reached a point where I'm hesitating on calling and am overwhelmed with the constant denials and obstructions.
And I had just made the decision in December to pay into private insurance again, instead of Medicare, because there are so many things that Medicare wouldn't pay for, home-nursing visits being one of them. I've so had it with fighting for every last scrap of anything, and too often coming up empty-handed. All while suffering mightily, of course, with the escalating illnesses. That's why I posted about a Patient Advocate.
Any suggestions? I do know that I need to call Oxford, make a complaint to the State Attny General's office, etc. I'm just worn out, afraid now, and dealing with multiple other medical/dental and insurance issues simultaneously. Plus, am having surgery on Tuesday to have my gallbladder out.
Posts: 3771 | From around | Registered: Mar 2008
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posted
Ugh, I'm sorry. Oxford is awful, I've had trouble with them in the past. Is there any way you can switch to a different insurance company??
I love how your doctor won't write them a letter... too afraid of the power of big corporations, I assume.
Hang in there. Insurance is a load of you know what.
Posts: 39 | From marlborough, ct | Registered: Nov 2009
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
Maybe you should put this on the backburner until you recuperate from the surgery. It can't be good to have the physical trauma of an operation on top of mental stress. Easy to say forget about it temporarily, but it might be a good thing if you could.
Posts: 2888 | From USA | Registered: Mar 2004
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
I can't get another insurance company (short of Medicare); this is through my husband's job, although we still have to pay a lot, it's not as much as if we had to do it on our own. With Medicare there are so many things that I need that they don't pay for. And none of my drs take Medicare.
I don't know why my dr won't write a letter. I think he just doesn't want to bother. Plus, he's already given them lots of documentation! I can't say here what I'd like to say about Oxford!!
Posts: 3771 | From around | Registered: Mar 2008
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posted
I hear you. It's so difficult. Insurance companies don't care at all about our well being, just about how much they can get out of us while giving as little as possible.
I agree with poppy though, this is a HUGE strain which you do not need right now. I understand it's incredibly stressful but try to take things one day at a time - I'm new to this, but I've read about people getting better on here with alternative therapies. Have you considered other methods of treatment?
Posts: 39 | From marlborough, ct | Registered: Nov 2009
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
I hate to say it, but I spent 3 1/2 years intensively doing alternative treatments (rifing with 4 different machines, herbs, ozone, colloidal silver, etc.), and didn't improve at all. I am a practitioner myself and know a tremendous amount about it. I also have done alternatives all along. But it's not sufficient for many of us.
I sometimes wonder if I should go back to rifing, etc., but abx helped a lot., where rifing didn't I just have run into so many treatment obstacles.
Posts: 3771 | From around | Registered: Mar 2008
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posted
This may or may not be an option. But what hubby does anymore is write his own letter to the insurance company and then e-mail the letter to the doc and ask them to print it out on their letterhead and sign it -- making any changes they want to make. Then you mail the signed letter to the insurance company yourself.
Of course most docs charge $50 or $100 to review the letter, but at least it does get done.
This is what we had to do to get hubby's SPECT scan approved both of the 2 times he did that test. After the neurologists messed up both requests we wrote the letter and took it to his current LLMD at the time and let them sign the letter.
Will talk to hubby tomorrow and see if he has any other suggestions. He is the insurance guru.
Do you have a copy of the insurance guidelines for IV IG? If they have ever denied that treatment then I am pretty sure they are obligated to provide you a copy of those guidelines if you request it. Of course they won't want to do that, but that is one of those things you can mention to the state and they can make them send you the guidelines. And then you can quote from those guidelines in your letter from the doc requesting treatment because of the following reasons......
That is what hubby did when they denied his SPECT scan because he did not have a brain tumor or epilepsy. But reason number 7 I think it was on the guidelines allowed the test for brain inflammation which we said was evidenced by encephalopathy etc.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
Ah, yes, thank you, Bea, I do need to ask for the guidelines. They very trickily have not formally denied it, which would make it easier to ask for them.
I've written letters for docs before, too. I need to know more exactly what their guidelines are in order to do this one.
The fact that they had authorized it until the end of Jan, and then used the changed orders to take it away is really a good one. And they have done that every single time the orders have changed.
Posts: 3771 | From around | Registered: Mar 2008
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Ugh, I'm sorry. Oxford is awful, I've had trouble with them in the past. Is there any way you can switch to a different insurance company??
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