IVIG and Medicare
 

This is more informational then anything - but for those of you on straight Medicare that may need IVIG - have discovered some real glitches in the system. I'm on Social Security Disability - with traditional Medicare and and "Medi-Gap" policy (an additional Medicare policy that I buy that pays my co-pays for all hospital and doc visits, but not meds) - and Medicare Plan D for prescirptions... there are truly no Medicare HMO's in my area with a competent enough network of docs to treat someone with multiple health conditions..

Found out two weeks ago my home IVIG agency will be dropping me at end of month. Did (and am still doing) lots of reserach... turns out traditional Medicare does NOT pay for IVIG done at home except for PID (Primary Immune Deficiency) - they had dropped it done at docs offices several years ago, and also many hospitals, while they still may do the infusions, dont because of reimbursement rates.. turns out the home nursing is not paid at all by Medicare for neuropathies as they are not an accepted treatmemt under the plan... and the home agencies make their money only by dispensing the IVIG med itself (being mixed by their pharmacies).... and make only a very small profit on Medicare patients to begin with... since my PLAN D dropped their reimbursement rates to the home infusion agencies on the meds, the agencies are dropping the contracts and patients are out of luck......

ALso learned that while the money is being made by these agencies on the private insurance side - Medicare patients are actually considered more of a philanthropic gesture... which looks like its going to be very hard to find....

I have no idea what I'm going to do... but does show that advocacy in this area, which is in process - really needs to be stepped up (and unfortuantely benefits get worse constantly)... also, on Medicare Plan D - IVIG is considered a "specialty med" - which after approval if you are lucky enough to have an infusion agency - you will always have a high co-pay for the med - a percentage of the cost for evey infusion - no such thing as topping out.....

One of the battles I'm fighting right now - learning lots - and finding out MUCH needs to be done in this area - such as have the neruo illnesses that we know are helped by IVIG - be recognized as such by our government...

Just some info - but any of you on straight Medicare or who are looking to make decisions in this area - something you really need to look in to!!!!!

To the mattresses as they say!

sorry to hear this has happened to you.
I'm on Medicare w/ state Medical assistance--which did pay for home infusions prior to Part D. since , I've been denied IVIG ; have been appealing for past year, unsuccessfully.

I'd hoped that my Dr, my Rep, in appeal would come up w/ something but .... hasn't. he knows Insurance Co don't want to pay for the expensive treatmts that DO help

I wish you the best in this fight. If you learn anything, ways to help in this fight, please inform & update...