Best Arguement to Insurance for IVIG

[Stickeen]

I have MMN. My insurance will not approve IVIG and I am on my third appeal. The insurance people want me to try steroids or clyclophosphamide first.

What is my best arguement in appeal?:confused:

[can]

I have no experience in these matters. Try to find out as many bad points about cyclophosphamides! Also find out as many bad points about steroids! Check out www.neuro.wustl.edu/neuromuscular/antibody/pnimdem.html IT states and I quote "NOT Prednisone: Prednisone may cause increased weakness " ( bottom of page 3 of 5 from the above web site talking only about MMN ) GOOD LUCK

[can]

Read ron's reply to can on the thread "MORE ALS & MMN & replies " Look at the web that ron mentions. GOOD LUCK

[Stickeen]

Thanks for your help. stickeen

[hunky from PA]

An article in the Dec-jan 08 issue of I.G. Living (www.igliving.com) states that "...studies indicated that patients with MMN show no signs of their condition improving or worsening when treated with steroids or palsmapherisis." It also comments on how effective IVIG is. Maybe this will help your cause. I also wonder if since Medicare covers IVIG treatments maybe they can share some wording to help your appeal?

[JanGK]

Please go to the website www.igliving.com and look at their assistance for reimbursement issues. There is help that they can provide in forming a letter that your Dr. can send to the insurance company with the "right" words that will get your letter looked at and responded to.
How scary for you to be in this situation. I am sure that once you get the IVIG people on your side to assist, there is strength in numbers- Good Luck!

[kaylish]

Hiya. What an awful situation for you to be in. I hope you can get some success with your third appeal. The one thing I do know about Ivig is that it is the only treatment available that does not 'suppress' the immune system. It 'modulates' the immune system and therefore surely has to be a safer option apart from the fact that there is a risk for the transmission of blood borne diseases.

[cheermom47]

Hi Stickeen - I had to do the same thing with my insurance company. My neurologist had to talk directly to one of "their" physicians, send his CV, and all kinds of information about MMN to them, also, we requested another party like a nurse case manager to act on my behalf, she coordinated a lot of things for me, it also helped that my insurance is self funded, I got the name of the president of the company and called DAILY until it was approved. Unfotunately in my case, it didnt help and neither did the Cytoxan I tried.
Best of luck to you!

CM

[powder pig russ]

Be persistent. Be persuasive. And if that doesn't work, be a pest. Because it's so invasive, Cyclophosmide is, in the words of my neuro, "the treatment of last resort." Besides, IVIg is the only treatment shown to have any success treating MMN in double-blind studies. Suggest that they read the Hippocratic Oath again - a portion of which invokes: "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect."

Russ

[can]

Read www.neuro.jhmi.edu/MMN/treatment.html This is from JOHNS HOPKINS and I quote " Cyclophosphamide: is perhaps the only immunosuppressive agent ( besides IVIG ) that has shown to have consistent efficay ( 50% ) in the treatment of multifocal motor neuropathy with 20 of 40 cases so treated showing improvement. Improvement has been reported to coincide with decrease in the anti-GM1 antibody titers which may occur between 2-5 months after initiation of the treatment. However, cyclophosphamide is not routinely given because of its toxic side effects, including bone marrow suppression, increased risk of infections, hemorragic cystitis, infertility, teratogenecity, alopecia, nausea,vomiting and an increased risk of hematological malignancies. Daily oral ( 100-150 mg/day ) or periodic intravenous ( 1-3gm/M2 ) regimens have been used for periods of 6 months ".

[Stickeen]

igliving.com has a Reimbursement department which deals with the very question I have. Thanks.

[fred]

I have MMN. My insurance will not approve IVIG and I am on my third appeal. The insurance people want me to try steroids or clyclophosphamide first.

What is my best arguement in appeal?:confused:

Also, there are several published articles in scientific journals like Neurology in which actual randomized clinical trials have demonstrated the effectiveness of IVIG in treatment of MMN. Try to get your hands on a couple of these papers and send them in as well. I had to fight this same thing years ago when I first started getting treated (1996). Since then I'm sure there are dozens of more scientific papers. Ask your doc to give you some of these for supporting your case.