IVig and insurance

[Bennalex]

I see the one sticky on this forum regarding insurance codes...I'm wondering if anyone else had luck getting insurance to cover it and if so, was it prescribed by an immunologist, fertility specialist, or other dr?
Everything through my fertility specialist is being rejected by insurance, even though they are coding it the same way my OB codes my tests and they are always covered. All of my appts and tests with him that were for RPL were turned down, yet all my RPL through my OB was covered. It makes me irate that they won't cover stuff for pregnancy loss just because he's a fertility dr. With that said, I'm wondering if I could somehow get a different dr to prescribe the IVig maybe I'd have better chance of coverage.
Any insights greatly appreciated!!

[Tabithalyn]

Sorry no one replied - have you tried searching the board here for this IVIg and Insurance heading?? I'm in Canada and IVIg was covered here (but not that readily available any longer thru a fertility specialist).

I wish you luck finding out how to code it - you could try getting in contact with Dr.Beer's office at www.repro-med.net and asking them how they go about coding the insurance stuff as I know most of their patients end up getting reimbursed as it is coded as an immunological disorder not infertility related.

good luck,
Ally

[Bennalex]

Thanks Ally. I have searched the forum and didn't really find anything. I had my first IVIG treatment on Friday and just about choked when I had to pay! Ughh...it feels so unfair to have to pay without any help from insurance. The nurse at my infusion center was so sweet, though, and gave me the names of specialty pharmacies to call and price IVIG. She said to call around and get the best price and if they can ship it directly to her center, she'll administer it for me. She seemed to think I'd be able to find a much better deal that way than what I paid on friday. She's willing to help in any way she can by talking to the pharmacies to make sure I'm asking the right questions, etc. So hopefully that will at least lead to a better price. If we have to pay what I paid on friday ($3700) each time, then I don't know what we'll do. It's preconception right now, so who knows how long I'll be doing it.
Thanks again!

[julize]

So far I've been able to get my insurance to cover it at 100% (knock on wood) but I deliberately went to an Immunologist and had him write the orders rather than going through an OB or RE. Because they didn't require pre-authorization the insurance company has no idea that my treatments have anything to do with fertility or RPL. I'm sure if they did they'd deny it.

FYI, my doctor used the diagnosis codes 279.4 ("autoimmune disease NOS") and 288.8 ("other specified disease of the white blood cells").

Good luck to you!