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Originally Posted by cure
We have just gotten the diagnosis for SFN *AND* a prescription for gammagard IVIG, and just when we were happy that finally it was figured out and there is hope for successful treatment - we started hitting obstacles with insurance and the pre-approval. We're in midst of appeals, but as I'm looking online for guidance, I'm finding how it has been difficult for people to get this covered.
Do people have suggestions for how to get this approved through insurance, or other routes through the system?
I am finding some clues but they lead to more questions.. ie:
-- Is it better/ does it make a difference if you are getting in-home treatment or go to an infusion center? Somewhere I saw it looked like the centers might be easier to get covered, but not sure.
It is not one of the Primary Immunodeficiency Diseases which (I am just learning) makes a difference. This is for a loved one, we are all just learning about how this all works.
Thank you for any help/ experience here.
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What state are you in? Your physician should be the one providing your insurance company the documentation for IVIG approval. You can call and speak with the patient coordinator with the specialty pharmacy where you might get your medication and they will be a great source of how to get the medication through your insurance. Also, if you cannot afford the copay you can ask for a financial waiver from the pharmacy (where you will get your IVIG). You can ask for a specific pharmacy and you do not have to use the one the physician says. You can also have your infusion at home vs going to his office or a suite. I will try and do what I can from my end. I am getting ready to start IVIG myself. I am an infusion nurse and have given tons of IVIG to patients. I'm not that well versed on the insurance side; but I know people.