IVIG was denied. How do I appeal?
IVIG denials are usually about diagnosis, antibody testing, prior treatment failure, dose, site of care, or whether the plan calls the use experimental. Appeal by matching the specialist's records to the IVIG policy line by line and separating clinical need from site-of-care or infusion-benefit disputes.
What to do, in order
- Step 1
Get the exact IVIG policy
Ask for the policy section for the diagnosis, not just the general IVIG policy.
- Step 2
Map every criterion
Diagnosis, lab values, severity, prior therapies, infection history or neurologic findings, dose, duration, and reassessment plan should each be addressed.
- Step 3
Separate drug approval from site of care
A plan may approve IVIG but deny hospital outpatient infusion. That needs a site-of-care appeal, not a drug-necessity appeal.
- Step 4
Use external review if upheld
Medical necessity and experimental/investigational IVIG denials are usually external-review eligible.
The deadline that applies
At least 180 days to appeal on employer and ACA plans. If interruption creates serious risk, ask for urgent review and explain the clinical risk in the specialist's statement.
Calculate your date →Documents to gather
- IVIG denial
- Diagnosis-specific IVIG policy
- Specialist letter
- Lab results or neurologic findings
- Prior treatment history and response
- Infusion-site documentation
Go deeper
Related questions
Is IVIG always experimental?
No. IVIG has covered uses, restricted uses, and disputed uses. The diagnosis-specific policy decides the route.
Who should write the letter?
The treating specialist, because IVIG policies are diagnosis-specific and technical.
What if the plan only denies the hospital infusion site?
Then focus on why hospital outpatient or supervised infusion is medically necessary or why home infusion is unsafe.
Sources
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