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Since You Asked: Question & Answer (June 2018)

June 29, 2018

These Questions & Answers originally appeared in the IDF monthly e-newsletter, Primary Immune Tribune. Click here to subscribe.

Question 1: Starting Ig Therapy
Question 2: Finding Health Insurance that Covers Ig Therapy

Question: I have been tested a few times and my IgG levels are under 20, yes double digits! I have had a lung infection for over six months and two abscessed teeth. My team of specialists want to do several things including two root canals along with lung, bone, and spleen biopsies. Is it safe for me to start these now? I would like to move forward, but the specialists want me to wait until I start Ig treatment.   

Answer: It is rare that we hear of IgG levels as low as yours. You and your specialists need to determine whether the benefit of having these procedures done prior to Ig replacement therapy outweigh the risks. Given your IgG levels, it is safe to say that you have been advised properly by your specialists. There is no need to put yourself at increased risk for infection if you are currently battling infections. Your doctor can request an expedited review for prior authorization to hopefully get your treatment started as soon as possible. We wish you the best of luck!

QuestionI am looking to purchase an insurance plan, and contacted my state’s marketplace. They told me none of the plans offered cover immunoglobulin (Ig) therapy, which I need. I gave them the names of all of the products available, and they said none of them are covered. What am I supposed to do? I need an affordable plan that will cover my Ig treatment.

Answer: Don’t panic! You were most likely misinformed by the customer service representative with whom you spoke. It is highly unlikely that all of the plans would have a specific exclusion of Ig treatment.

Remember, when you first call an insurance company you are speaking to a basic customer service representative who is referring to the benefit plan summary. They were probably looking at the prescription drug list when you gave them the names of the Ig products. These products are not going to be on the prescription lists.

When trying to obtain information on coverage specifics and out-of-pocket costs, insist on speaking to a supervisor or a manager. Give them as much information as possible so that they can look into this for you. Explain that Ig replacement therapy is a medical treatment that requires prior authorization for coverage. Provide them with your diagnosis code, the Ig product code (J-code) and any other billing codes. This will help you get to the appropriate person who can answers your questions about coverage. Good luck!

These answers should not be used as a substitute for professional medical advice. In all cases, patients and caregivers should consult their healthcare providers. Each patient’s condition and treatment are unique.

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