rlbrussell

IVIG COVERAGE

4 posts in this topic

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

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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)

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now