While IVIG is an expensive therapy many insurance companies will authorize its use for patients with MS. Some insurance companies will require documentation from the physician that indicates that the patient is suffering from relapsing-remitting MS. Most often a letter of medical necessity must be submitted from your doctor to the Medical Director of your insurance company before IVIG can be approved.
The Letter of Medical Necessity includes:
- Patient's name
- Insurance carrier
- Policy number
- Type of MS - chronic, progressive, relapsing-remitting
- Clinical symptoms
- Neurological findings
- Previously tried therapies
- Diagnostic tests to support the diagnosis
- Treatment recommendations including the dose and frequency of IVIG
Along with the letter specific studies that have shown IVIG to be beneficial in the treatment of MS are also sent to the insurance company to support the request and expedite authorization.
Providing all of the information upfront to the insurance company most times guarantees a swift approval.
Specific insurance carriers have policies regarding the use of IVIG.
At the present time, Medicare does not reimburse for IVIG for its members with MS. Some physicians and providers have been successful getting approval on a case by case basis through the Medical Director.
Most Medicaid programs cover the cost of IVIG for MS for their members. Prior approval may be necessary. A certified nursing agency or Medicaid approved agency is required to provide nursing care. Some states require prior authorization for the equipment and supplies that will be used for administering IVIG.
Reimbursement specialists will help you to identify whether IVIG would be covered by your insurance carrier. If you have any questions or we can be of any assistance, please feel free to contact us at:
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