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IVIG COVERAGE


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#1 rlbrussell

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Posted 05 September 2008 - 06:03 AM

I was just wondering if anyone has been successful getting approval for IVIG through Blue Cross Blue Shield? My doctor wants to try it for my scleroderma which is really active right now. I also have polymyositis but it is completely under control. I hope we can get it approved.
Rosa
Diffuse Sclero
dx Jan 2006

#2 Peggy

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Posted 05 September 2008 - 06:29 AM

I have BCBS and they denied it. I then appealed it and through the appeal process the doctor/s who did the review determined I had actually met the criteria for it and approved it for 3 months, which ended in June. Now we have to prove to BCBS that it worked. How that's being done is too have Polymyositis along with Systemic Sclero, Sjogren's, Raynaud's, Mixed Connective Tissue Disorder; Peripheral Neuropathy, and Thyroid disorder.

Well BCBS will look at my first CPK numbers which were off the charts. Then after the IVIG they went to normal. Now I go back in October and if my CPK went back up then my doctor will show BCBS that they need to approve more treatments as they were working.

At first I didn't think they had done much. But just last month I noticed less leg pain for a little while and more strength. Now all that I gained is gone and I have the pain back worse than it was before and has now progressed to the hips.

I hope this helps.

Warm hugs,

Peggy

#3 janey

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Posted 05 September 2008 - 08:53 AM

Rosa,
BCBS approved my IVIg treatments on the first go around; however, it was submitted to treat my polymyositis rather than my scleroderma. Using my CPK results, my rheumatologist has managed to get continued approval for 2.5 years now. I hope it continues. As much as I dislike the process of sitting in a chair for so long and multiple sticks, I love the results. It's really given me my life back.

Peggy, I'm so glad to read that you finally experienced some positive results from your treatments! Sorry however, that the step forward has now become another step back. Hopefully, you'll get approval for another series of treatments with maintenance treatments to follow. I'm up to every 8 weeks and that seems to be about right.

Good luck to you both,
Janey Willis
ISN Support Specialist
(Retired) ISN Assistant Webmaster
(Retired) ISN News Director
(Retired) ISN Technical Writer for Training Manuals
International Scleroderma Network (ISN)

#4 RememberingToSmile

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Posted 07 September 2008 - 09:17 AM

I've been getting IVIG with standard federal BC/BS for 5 months now. Officially it is for scleroderma code, but deep fibroinflammatory involvement and diagnosis of inflammatory myositis and inflammatory arthritis is in my records.

Whether the insurance needed to approve or not - was never discussed. I guess I was lucky and the doctor's office took care of any paperwork, etc. I paid a share of it the first 2 times, but then hit the "Catastrophic" ceiling and now pay nothing for the rest of the year, even prescriptions and co-pays are covered. I push my husband to get all his routine work completed now.

Hope all goes well.

-RTS