[CIS PIDD] [cis-pidd] bronchiectasis + PI

[CIS-PIDD]

I have a 38 yo woman with bronchiectasis and IgG subclass deficiency on a single occasion, 72% response to Pneumovax, normal immunoglobulins, CRSwNP with AFS and fungus balls, 6 sinus surgeries, MRSA with numerous other gram negative organisms, fungi and nontuberculous mycobacteria.  She has been on oral and IV antibiotics, antifungals, zileuton, montelukast, oral and topical steroids, Propel nasal steroid implants, omalizumab, etc.  Her asthma was also previously poorly controlled but no AERD.  She did not tolerate allergy immunotherapy,

We received approval from Cigna for IgG replacement for 2 years, during which time she improved continuously.  Now her insurance company refuses to continue approving it.  I am concerned that with all of her problems she will worsen dramatically given her severe disease.

This insurance company's policies are inflexible. (They also have an improper definition of CVID). I have already had a similar patient who had IgG replacement refused by Cigna and was also denied on external appeal, but when his employer consulted with 2 outside allergist/immunologists, they both agreed that he should receive it.  Cigna is unwilling to change their position and maintains that the external appeal is legally binding and will not change.

Do you have 1) opinions about the case and 2) any suggestions on dealing with the insurance company?

Sincerely,

Wellington S. Tichenor, M. D.
642 Park Avenue
New York, New York 10065
212 517-6611
wtichenor at sinuses.com

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