For many living with primary immunodeficiencies (PI), immunoglobulin (Ig) replacement therapy is a lifesaving, life-long therapy. The healthcare providers caring for those with PI can play an integral role in ensuring their patients have access to the treatment they need. The following includes recommendations when a provider is seeking prior authorization of Ig therapy. In all cases, however, the patient and/or caregiver must work closely with their prescribing provider and their insurance company to ensure treatment is covered.
It is recommended that people with PI contact their insurance company and request a case manager to help coordinate care and services, should the plan provide one. Major medical coverage typically includes doctor’s office visits, hospitalization, medical supplies and services, prescription drugs and other healthcare expenses. The policy may require preauthorization from the plan before moving forward with a treatment, may deny coverage, or may provide coverage that makes the care available but unaffordable.
For providers, the prior authorization process typically involves:
Below are some tips from a clinical immunologist that has been successful in overturning Ig denials:
If you have further questions, contact IDF.
This page contains general medical and/or legal information that cannot be applied safely to any individual case. Medical and/or legal knowledge and practice can change rapidly. Therefore, this page should not be used as a substitute for professional medical and/or legal advice.
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