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

[CIS-PIDD]

I this situation I have advised the patient to obtain legal representation
and file a suit claiming arbitrary and unreasonable denial of services. The
lawyer filed suit and filed discovery demanding the deidentified records of
every patient approved and denied IG therapy in the previous 10 years.
Forty-eight hours later, her IG was approved.
Good luck,
Richard Wasserman
Dallas

On Thu, Apr 13, 2017 at 5:50 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> 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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-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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