Home Infusion- MD write order for nursing portion (neurologist out of state?)

For those on IVIG who see an out of state neurologist, have any of you had an issue with getting an order for the infusion portion (nursing component)? My neurologist from the Cleveland Clinic wrote the order for the IVIG, but the nursing component has to be ordered by an instate dr. My MD, despite her knowledge of my diagnosis, access to my medical records & release to coordinate with my neurologist, refuses to write it. She suggests I see a local neurologist in her network. I’ve had several infusions already; this was an oversight. I’m concerned this will delay my upcoming infusion. Any advice is appreciated.

This is not true. My neurologist is from a different state but the nursing services is done in my state. Your home health agency needs to be different. Call your insurance company and ask them for a nursing agency that has multiple state certifications. This should not be an issue. The nurse must practice in your state and the agency needs to have the ability to practice across state lines.

Infusions made me break out in large patches of hives. The co pay on my insurance was 1200.00 per I’ve. I could not afford that. My neurologist is using Rex Cellcept which has helped 5% in 3 months

I really appreciate the feedback. So blessed to have this site. I didn't even think of another home care company that may be able to operate (license) across state lines. Good idea!

It's good to know what is reasonable and sounds like I am expecting something from my MD, that is maybe not the norm. Of all the relationships, the neurologist is the last I want to change.

I will call my insurance on Monday. The infusion company I have is ok (nothing prior to compare); it was 1 of 2 recommended by the clinic. The clinic treats a lot of out of state patients & I was told that the MD relationship was important for local orders. The idea of nursing component was never specifically discussed though. Then, the home care company said they've seen this before and the MD wrote the order with no issue. Who knows!

I will try this avenue and update my outcome, in case someone else comes across this. Thanks again!

Try Acreedo they are multi-state

Sorry to say this my MD she is from Inida and she will only ref me to a doctor from India me and my wife both herd her say over the phone that I have good insurence so we felt she did not have my health as her best interest so we said goodbye to her

With a different health care system in the UK-for the time being at least-I haven't met these problems but I have decided against home care.After 90 infusions I recall the one time it went wrong and I went into spasm and vomitted uncontrollably when hospital care came in very handy.If you would be home alone too during the procedure any risk assessment will tell you your risk goes up.

My Neurologist says he's giving my body a massive steak every 4 weeks.lay down when he first diagnosed me all the risks associated with IVIG which I recall to the letter,reasons I will continue to have the infusion in the hospital.The downside is the infection control standards in hospital-MRSA etc which has been tackled in my hospital,2 MRSA test swabs every visit,and of course institutionalisation for one day only.Fortunately,they accept Orem's self-care model of nursing which I know from my own ex-work in mental health nursing too.It's all about the locus of control which means I get on with my own devices and cause as much mischief as possible!

Good luck and I hope it turns out well for you.

Your infusion company will be able to find in state nursing- you do not have to do that for yourself. Do ask, though, that the nurse have experience infusing IVIG to neurology patients- it's not something all nurses are familiar with. Good luck! Lauren

Wanted to circle back:
- MD approved my infusion nursing order - Good news!
- Home infusion manager talked directly to my MD. She eased concerns about the order.
o The way the order reads in terms of insurance approval was alarming to MD. She did not want to be responsible for the ongoing treatment/medicine itself. That part I understood.
o There were prior conversations with her and her office, but this last one helped.
- Michigan law requires the nursing order to be written by a Michigan provider (e.g. PCP or neurologist). I found out my homecare company operates in various states, but they still need the nursing order (administration) to come from a local dr. IVIG order itself can come from out of state.
o I confirmed this law with the Clinic and another local infusion company whom my insurance recommended.
I plan to maintain the open dialogue with my MD on my progress and hope she continues to feel comfortable with the orders.

In case the issue returns, I will ask the clinic again for a few MDs who write these type of orders. They obviously have seen these arrangements with other
Michigan patients. Maybe, they will provide some names.

I heard a local neurologist speak on CIDP and was equally impressed with his knowledge, but I am very hesitant to change neurologists if not required.