Question About Iv Ig

[rubytuesday]

My Infectious Disease doctor, my hemeoncologist and my allergist/immunologist/pulmonologist all tell me that I need IV Ig as I don't make enough antibodies. The Infectious Disease doc had mentioned something about insurance authorition for the treatements at in-network infusion center. The Cancer Center's immunologist was 'arranging' my treatments at its (in-network) Infusion Center who called me today to set start date. I asked the nurse if it had been authorized by my insurance. She told me she didn't know anything about pre-authorization and would have to refer it back to that specialist's office. I tried calling my retirement system but as it was a question about medication authorization, it's automated line puts me to Express Scripts (who had told me unless they had diagnostic/billing 'codes' and the name of the gammaglobulin, they could not tell me if it required preauthorization or not.

I called my medical insurance carrier and the nurse told me at first that if the ambulatory infusion center was in net-work it is covered, but I told her I realized that, but I did not want to get an EOB that shows the infusion center services were covered but then get a big denial on the gamma globulin itselt if it needed pre-authorized. She too said that the specialist's office could call the phone number on my medical card and give them the code and she could tell them if covered or not.

She told me Infusion Centers don't require pre-authorization, but then when it will come to home infusions, with Home Health Care, that needs to be pre-authorized. So I am confused. The nurse was lunching when I called specialist's office but never returned my call. Do those of you who receive gamma globulin at Infusion Centers require some sort of pre-certification for the treatment?

[arizona girl]

Hi, ruby, I have aetna and had united healthcare before that. I infused at infusion center and it all had to be preauthorized the IVIG and the infusion center. Annually, the insurance requires reauth. I just got approved for 2012, then my docs office added auth for home health at my request. I'd double check with both the infusion center and the specialist who ordered it, there staffs usually do all the paperwork for you, the insurance companies usually try to challenge this type of treatment. So in a nutshell, at the expense of these type of treatments, I really doubt they will schedule for infusion without all the insurance paperwork being in place. You should also get some kind of notification from your insurance company. You might want to ask your insurance to assign you a case manager to help you.

Ask your doctor what brand of IVIG and how much they are prescribing for you. I get 500mg which has to be infused over two days. Also ask what diagnostic codes they are using to diagnosis and order treatment for. You should know all those things before they start you.

Good luck and remember to follow the tips I gave you, so you have a good infusion experience.

[rubytuesday]

Thank you arizona girl,

I have Med Mutual and its nurse told me she could tell the specialists office if/how precert could be done if they gave her the med/reason (codes). I am glad I didn't go ahead and schedule my appointment when the infusion center called (since she said she didn't know anything about preauthorization--that all that would have been done by specialist's office). They didn't call me back yesterday but I did leave a meassage again this morning. My going to infusion center doesn't require pre-cert with my plan but home care does. And I sure would have hated to get a surprise huge bill for the IVIG after the fact due to an oversight.

[rubytuesday]

Hi, ruby, I have aetna and had united healthcare before that. I infused at infusion center and it all had to be preauthorized the IVIG and the infusion center. Annually, the insurance requires reauth. I just got approved for 2012, then my docs office added auth for home health at my request. I'd double check with both the infusion center and the specialist who ordered it, there staffs usually do all the paperwork for you, the insurance companies usually try to challenge this type of treatment. So in a nutshell, at the expense of these type of treatments, I really doubt they will schedule for infusion without all the insurance paperwork being in place. You should also get some kind of notification from your insurance company. You might want to ask your insurance to assign you a case manager to help you.

Ask your doctor what brand of IVIG and how much they are prescribing for you. I get 500mg which has to be infused over two days. Also ask what diagnostic codes they are using to diagnosis and order treatment for. You should know all those things before they start you.

Good luck and remember to follow the tips I gave you, so you have a good infusion experience.

So here we go again. The specialist's office just called me to tell me that they have sent all the necessary information to the infusion center after my call yesterday and that it is the responsibility of the infusion center to secure the authorization. So I am to sit and wait for word back from the infusion center to see if/when it goes through to schedule appointments. Got to love the process.

[corina]

i'm sorry rubytuesday! if only we could make arrangements all by ourselves it would def go much more efficient. i hope this treatment (once started) will help you.

corina

[rubytuesday]

Just giving an update as to where things stand (was diagnosed with IgA and IgG deficiencies as in my post and sick with laryngitis since Christmas eve). I saw my third doctor from the cancer center today, Jan. 5th--this one an otolaryngologist referred to me by immunologist/allergist/pulmonologist at cancer center Dec. 19th for Vocal Cord Disorder. I was to have a swallowing eval along with my other nasolaryngoscope but specialist did not feel it necessary. To sum: chronic laryngitis most likely secondary to immunodeficiencies. Also vocal cord disfunction that I am to take 2 speach therapy sessions to learn breathing techniques at home--seems things close up as I try to exhale, explaining why I feel I cannot get in good air (I didn't understand the explanation). I am also to start Cevimeline which is used to treat Sjorgrens (not that he is diagnosing me with that) but said that things are very red/inflammed/dry and the dryness is most likely causing the swallowing problems. He said there were a few Rx's I was taking that could be making things drier (recently had to add Rx for dry eyes). And have to see him back in 2 months to check progress. I was still only 90.3 lbs. He told me the immunologist/allergist had planned other testing for me at next visit. She had mentioned some skin testing and latex patch but I am not certain.

My Infectious Disease doc got me approved for gammagard (but I read that it is contraindicated in IgA deficiencies?). I have tried calling my immunologist to see what agent she was planning to use (she had stated it would be 5 IV transfusions consecutively--like over 5 days, then if tolerated, setting up with home transfusion with home health care assistance. (My Infectious Disease doctor shared with me that it costs less getting IV IG in infusion center than with home care).

I called ID's Infusion Center he uses to ask about gammagard and IgA deficiency and she is to ask my ID and pharmacist. That infusion center gives 15 (units?) weight based over about 2 hours pre-treating with benadryl and tylenol. The nurse there speculated that perhaps the immunologist at university wanted 5 consecutive day boost in order to begin with smaller dose, leading up the the 15 (if she is also planning gammagard). Will be interesting to find out so I can make decision.

If both are giving gammagard--would you go closer to home and get it IV once/month under constant supervision of nurse or would you do university recommended 5 day consecutive dosing under nursing supervision/immediate access to ordering specialist, and then to comfort of your home with less supervision, but guidance of home health care nurse? The first is about an hours drive (longer if snowy/icey). The university is nearly 2 hour drive (longer if snowy/icey). I would appreciate any suggestions. The closer infusion center told me that even if they have the name of the agent the university immunologist is planning to use, it would still only give it once/month ('we've never given it consecutive days, ever'). A little voice inside me tells me maybe I should stick to immunologist at University's plans. What would you do?

[rubytuesday]

So here is where things stand today. My ID set up gammagard infusion (IV, monthly at Infusion Center) but that was not same as immunologist/allergist/pulmonologist at University MC had discussed w/ us--said something about 5 days consecutive then once/monthly at home. Still not hearing from Infusion Center at University who according to the University specialist's office in Dec. was getting IVIG authorized by my ins., I called specialist to ask what agent (2nd call and an e-mail not returned) and which infusion center. Nurse called me late today and said it is Privigen and told me the Infusion Center site but added that 'they do not talk to paitients. . .and it is their responsibility to get the authorization. . .we don't do that in the office anymore'. So I called my insurance to see where things were in this authorization process and they'd never received any requests from University. So I 'MyChart'ed again to my specialist at University telling her that her office and infusion center are giving me run around and my insurance tells me nothing has been requested to be authorized, asking if someone could please help. I also called the Infusion Center (still with laryngitis since Christmas eve, barely able to speak) and the girl did get to a nurse and told me they only had an order for the Privigen (but no dose/frequency, etc. from specialist--yet they had called me 3 1/2 weeks ago ready to set appointment for me to get my dose???). The infusion center told me they'd contact University specialist to get the infor they need.

The University specialist called as soon as I e-mailed. She told me that now instead of 5 consecutive IV infusions, she thinks it will be alright to just procede with sub-cutaneous injections with Home Health Care considering the long travel and wintery roads. She said their office will work on this tomorrow. The Infusion Center at Infectious Disease offered to check w/ my ID and pharmacist to see if it would be ok to do IV Privigen (still do it once/monthly).

My ID doc mentioned that it's cheaper to get it in infusion center (IV) than the overall cost of home care/home pharmaceutical supplier and the cost of equip. My insurance company still does not have the benefit book available on-line so I can't tell anything about what my co-pay will be for HHC vs Infusion Center. Anybody have any experience with this? Thank you all so much for your patience and guidance.