Hi all,

 I have been getting IVIG ( just changed to sub Q.. it is wonderful )  from 1993. Medicare ALWAYS paid.

 Last infusion  I got in hopital , IVIG, Medicare , via their contracted review co  MAXIMUS, refused to pay for the IVIG, the hospital appealed they refused on appeal.

 The reason they gave was ( I am using lay person short terms ) 

 this person does NOT have CVID..... IVIG is for those with PIDD ( CVID ) .. we know he does not have PIDD because...

 This is direct copy from letter of denial of appeal .... "  medicare requires the following diagnostic evidence to support a diagnosis of CVID:

-Lab test reports demonstrating a IgG level of less than 400 milligrams per decliter ( mg/dl )  for the asssay utilized and

-Lab reports demonstrating a lack of ability to produce an antibody responce to a protien antigen........ two or more immuzations should  have been given in the 12 mos prior to the lab assesment of anti body responcese. "

 I assume this means that if your IGG level is above 400 you , de facto , cannot have PIDD ( CVID ) ; and Medicare will not pay .. period. 

 I am now wondering how to over come this conclusive presumption of no disease if  one is above 400 level .  Has any heard of this ? I assume about 80 % of all PIDD folks ( because they DO get regular IG infusions ) are above 400 , or hope they are. I began at about 233 IGGs and after years got up to about 500- 600 IGGs and now a m above low normal range.. about 1,000.

 This is a serious isse. Can any help me proceed and suggest next step ?

 Thanks for you help and concern. This might well effect ALL  PIDD folks with IGG levels above 400 ?? Not sure..??

 Thanks

 Take Care,

 smallinn