Doctors/Insurance

Reproductive Immunologists in the United States

(More doctors outside the US listed in the Immunology FAQ page)

Source: the Files of the Reproductive Immunology Support Group http://health.groups.yahoo.com/group/immunologysupport/
There are only a handful of doctors who specialize in reproductive immunology in the whole country.  For more specific information on each doctor, please visit their websites or check out the link above for the immunology support group.Most of these doctors will treat patients long-distance after the initial evaluation, so do not lose heart when you see how short this list it!

Dr. Jeffrey Braverman

Offices in Manhattan and Long Island, NY

website: http://www.preventmiscarriage.com/

phone: (855) 786-7775

Dr. Joanne Kwak-Kim

Rosalind Franklin University

Vernon Hills, IL

website: http://www.rosalindfranklin.edu/faculty/KwakKim_Joanne.aspx

phone: (847) 247-6900

The Alan E. Beer (AEB) Center for Reproductive Immunology & Genetics

Dr. Raphael Stricker, Dr. Gerald Trobough, and Dr. Edward Winger

Los Gatos, CA

website: http://www.repro-med.net/repro-med-site2/

phone: (408) 356-9500

Reproductive Immunology Associates

Dr. William L. Matzner, Dr. Penny J. Chong, and Dr. Wendell T. W. Ching

Agoura Hills, CA

website: http://www.rialab.com/index.php

phone: (818) 781-5195

Patient report on Matzner from March 2013: “Dr. Matzner charges an outrageous amount of money to test blood every month. Someone can correct me if I’m wrong but the amount of re-testing he does is over kill. Especially since he will not work with you on insurance. He does a thorough job of initial testing but IMHO that’s all he’s useful for.
As far as monitoring goes he should not even offer that service. I retested with him, used him for Intralipids, for one month but still miscarried. They never even knew I miscarried and never followed up with me. He is a Geriatric Internist and does Immunology once a week.”

Some doctors who might be willing to collaborate with RIs can be found here:

http://www.riforpatients.com/collaborating-doctors.html

Insurance

Random info regarding United Healthcare:

IVIg has been approved by UH with the following diagnostic codes: 279.4, 288.8, and 795.79.

Here is the link to the UH policy on IVIg and acceptable diagnoses.

A friend just got her IVIg approved by UH and this was her recipe for success:

“1) review the latest UHC policy on IVIG coverage, and try to find diagnosis codes that are applicable to you, and make sure you are not using anything that is in the “unproven” ; list.
https://www. unitedhealthcare online.com/ ccmcontent/ ProviderII/ UHC/en-US/ Assets/ProviderS taticFiles/ ProviderStaticFi lesPdf/Tools% 20and%20Resource s/Policies% 20and%20Protocol s/Medical% 20Policies/ Drug%20Policies/ IVIG_DP.pdf

2) have a script for IVIG faxed to the provider (I used Walgreens Home Infusion, and mention the diagnosis codes). Work with them on what then need to have this approved, might as well send them everything below and let them use whatever they think might help.

3) prepare med necessity letter (I am attaching mine below), and include the diagnosis codes in the header and conditions in the body of the letter. make a point of talking about immunologic issues, not fertility issues.

4) provide any lab work that supports the diagnosis (we used ReproSource results with high NKs, cytokines, and some regular labwork that shows inflammation in my case). If this is for renewal, show that the results improved after the IVIG therapy.

5) we referenced the research articles in the letter, but you can also print them out and make them part of the package.

please feel free to contact me with any Qs.
I hope it helps!!!

************ *******

LETTER OF MEDICAL NECESSITY FOR INTRAVENOUS IMMUNOGLOBULIN THERAPY

Patient Name: XXX
Ref #

Diagnoses:
279.4 (Autoimmune disease not elsewhere classified)
288.8 (Other specified disease of white blood cells)
795.79 (Immunologic Dysfunction)
555.9 (Crohn’s disease with arthritis)
245.2 (Thyroiditis, autoimmune)

The above referenced patient has been diagnosed with immunologic dysfunction and autoimmune diseases based on a long history of Crohn’s disease and Hashimoto’ s thyroiditis. Associated with these conditions, she has also developed adverse immunologic factors including anti-thyroid antibodies (ATAs), activated Natural Killer Cells (NKs1), and severely elevated pro-inflammatory Th1 cytokines which include TNF-alpha and interferon-gamma. These inflammatory cytokines have resulted in persistent colitis symptoms from the Crohn’s disease as well as elevated ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein). The conditions likely contributed to the patient’ s history of repeated miscarriages as well as the most recent failed pregnancy in October of 2012.

The patient’ s condition is known to be associated with a variety of manifestations of reproductive failure including, but not necessarily limited to, implantation failure presenting as infertility, recurrent pregnancy loss, intrauterine growth retardation (IUGR), intrauterine fetal death (IUFD), and the development of maternal complications, such as thrombosis, stroke, and transient and ischemic episodes.

The overall immunologic problem requires infusion with Immunoglobulin G (IVIG) before and during pregnancy. Ample evidence exists to support the fact that patients with serologically demonstrable levels of ATAs, NKs, and excess proinflammatory cytokins such as TNF-alpha and interferon-gamma may benefit from immunotherapy. Further, other perturbations of the immune system, including activation of T cells and polyclonal B cells, and ATAs, if associated with NKa, represent an additional indication for IVIG treatment. Studies show that patients with high NK cell activity that suppress with IVIg in the NK assay, like in the case of Mrs. XXX, will respond very well to intravenous immunoglobulin (IVIg) therapy. In fact, the live birth rate with preconception IVIg is more than 80%, compared to 20% without treatment (please see attached some of the articles to support the rationale summarized above).

The recommended regime of IVIG therapy is as follows:
Thirty (30) grams of IVIG (to be infused every three weeks until at least 20 weeks of pregnancy.
Without such treatment the patient will be at risk for the development of the complications referred to above.

Please call if you have any questions or concerns regarding the Immunoglobulin G Infusion (IVIG) therapy.

Best regards,
Dr.Name, MD

____________ _________ _________ _________ _________ _________ _
1 Natural Killer cells are a type of immune cells called lymphocytes. CD3-, CD56+, and CD16+ are types of NK cells.

Attachments:

Lab work:
Labcorp (multiple dates)
Reprosource (date)

Articles:
http://www.ncbi. nlm.nih.gov/ pubmed/22509929
http://www.ncbi. nlm.nih.gov/ pubmed/9553645
http://www.ncbi. nlm.nih.gov/ pubmed/16305665

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2 responses

17 10 2013
Rebecca

Have you had any success or heard of how to get Neupogen approved by insurance?

21 02 2014
Georgette

The only way (that I know of) is to have a qualifying condition. I actually was diagnosed with neutropenia (naturally occurring low white blood cell count) by a hematologist– which would qualify!!!!!– but he was unwilling to prescribe neupogen because I told him I was trying to get pregnant!!!! OMFG. And Dr B believed that even with the diagnosis, any Rx from a nonhematologist would be looked at askance by insurance. I have some neupogen in my fridge if you need some. Email me privately– georgetteoden at yahoo dot com.

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