Reinstating IVIG Coverage

Patient Story

Lifesaving Gammagard therapy approved for a pediatric PANS patient

Condition

Pediatric Autoimmune Neuropsychiatric Syndrome (PANS)

Treatment

Gammagard Liquid

Denial Reason

Investigational; not medically necessary

Denial History

Traditional channels exhausted

The Denial

After 8 years of stable, insurer-approved IVIG treatment for PANS, a 16-year-old boy’s new employer-sponsored plan through Blue Cross Blue Shield of Michigan denied coverage—threatening his medical progress, educational access, and mental health. Despite documented success with in-home Gammagard infusions and worsening symptoms following a 5-month care gap after discontinuation, the insurer claimed his condition was investigational and unsupported. His mother, a former nurse, had already exhausted every traditional avenue. Claimable was her last hope to reverse the denial before further deterioration.

The Appeal

Claimable guided the family through a personalized, evidence-backed appeal that:

Asserted continuation criteria based on long-standing treatment—not new initiation standards
Documented past medical necessity, in-home safety, and clear clinical benefit
Included expert support from the treating neurologist with over 40 years of experience
Highlighted regressions after treatment interruption
Invoked policy inconsistencies, excessive documentation requests, and ERISA protections

The Result

Within days of submission, the appeal was approved. The child’s IVIG therapy resumed, sparing the family thousands in out-of-pocket costs and restoring access to the only treatment that had meaningfully improved his health.

This isn’t just an appeal — it’s the fight for our son’s future. Claimable helped us win it.

Patient's mother