Saturday, November 19, 2011

IVIG Denial Update

Out last update shared the news of insurance denial for Elias' IVIG infusion, a treatment he has been receiving for two years. On Thursday evening the insurance company finally contacted his bone marrow transplant doctor for the peer to peer review that had been scheduled for earlier in the afternoon. The nurse coordinator called us afterward and was a touch frustrated by the call. Essentially this call was just to screen the situation to determine if this was even worthy of a review. After the insurance company's doctor asked and received all the information he wanted he told them, "If you fax everything over to us within the next five minutes, it might be reviewed next Tuesday." That meant we had to cancel the IVIG scheduled for yesterday. If the insurance company does indeed get to review this Tuesday we might be able to have it the end of next week. On Friday morning the insurance company called again requesting even more information. They were inquiring on Elias' immunization record of Pneumococcal Conjugate, which he had received on schedule in 2008. However, his titers for this are obviously showing little to no response. This will further strengthen and support the necessity of IVIG, not that there isn't enough there already. So there is quite a bit of confusion as to why there is so much questioning about this. In fact Elias' last IGG level are well below the max level according to the Insurance company's matrix of necessary therapeutic dosing. So everyone is really having a difficult time with this resistance. We were told his doctor made it very clear that if they continued to deny this, Elias would likely be hospitalized for any number of potential causes because of this - history supports that statement as well. His levels have been too erratic and unstable recently. All we can do know is continue to pray and hope for a swift resolution. Monday morning the team will pursue some potential backup plans or next steps should the denial uphold. We will be watching Elias like a hawk and lower our threshold and comfort level if he is having "an off day." We do not want to take any chances given his past history of being nonclinical for a great many issues. Hopefully by Thursday we will have a resolution and will be able to add it to the list of things to be thankful for this Thanksgiving Holiday. As always thanks for the continued thoughts, prayers and support.

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