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Click ‘Get Form’ to open the bcbs intravenous immunoglobulin request form in the editor.
Begin by filling in the office or facility name and contact details, including FAX and phone numbers. This ensures that all communications are streamlined.
Next, provide patient information such as Group #, Patient Name, Subscriber #, and address. Accurate details here are crucial for processing claims efficiently.
In the diagnosis section, clearly state the primary and secondary diagnoses along with their respective dates. This information is vital for medical review.
For Part A, indicate whether serum immunoglobulin assays have been performed. If yes, report the results and relevant dates in the provided fields.
In Part B, list any criteria or positive tests used to establish the diagnosis along with their dates.
Finally, outline the proposed treatment program in Part C, including IVIG dose and frequency. Don’t forget to include any complications or additional symptoms that may be pertinent.

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What insurance covers IVIG?

Covered Doses: Up to 500 mg/kg/week given intravenously. Increased doses or frequency are covered, as needed to maintain serum IgG levels 400 mg/dL.

How to get IVIG approved by insurance?

Privigen is intravenous Ig, given through a needle into a vein. It is administered by a nurse or doctor, and you can receive your Privigen infusion in a hospital, infusion clinic, doctors office, or even in your own home. Your doctor will determine the right dosing and administration schedule for you.

Is IVIG covered by BCBS?

Depending on the plan and the clinical documentation needed to receive authorization, the process can take days or even weeks. If the situation is urgent or life-threatening, an expedited authorization process can be requested.

How to get intravenous immunoglobulin?

However, this treatment can be relatively expensive. For instance, a single IVIG infusion can cost anywhere from $100 to over $350 or more per gram.

Does BCBS cover IVIG?

To cover IVIG treatment, most insurance companies require prior authorization. Prior authorization refers to the decision from an insurer that deems a drug to be medically necessary. Medical necessity assumes that a drug is necessary to treat the signs or symptoms of a disease.