Fscig Hyqvia denied due to quantity / dose limits by Cigna?

Cigna's specific coverage criteria for fscig hyqvia are defined in its own published medical/coverage policy and the FDA-approved prescribing label. A successful appeal documents that your medical records satisfy each criterion those sources list — confirmed diagnosis, any required prior treatments (with dates and outcomes), and clinical severity. If the exact criteria weren't included with your denial, request them in writing; your appeal then maps each requirement to the matching fact in your chart.

## Why Cigna Denied HyQvia for "Quantity Limits" — and How to Appeal

Cigna applies quantity or frequency limits to HyQvia (immune globulin infusion 10% with recombinant human hyaluronidase) infusions based on dosing parameters set out in its clinical coverage policy. A quantity-limit denial typically means the amount prescribed or dispensed exceeded the threshold Cigna's system will automatically approve. This does not mean the quantity is clinically inappropriate — it means you must demonstrate to Cigna that your individual clinical situation justifies the amount ordered.

## Why This Denial Is Appealable

Immune globulin dosing is individualized. The FDA-approved prescribing information describes dosing that is calibrated to the patient's weight and clinical response — meaning the right amount for one patient can look very different from another. If your prescriber has determined that the quantity ordered reflects sound clinical judgment for your specific case, an appeal grounded in your chart and the prescribing label can succeed. Quantity-limit overrides are among the more routine wins at internal appeal when the clinical rationale is well-documented.

## Federal Appeal Framework

• Internal appeal — File within the timeframe on your Explanation of Benefits (often 180 days). Request Cigna's coverage policy and the specific quantity limit applied; ERISA §503 requires the plan to provide criteria used in the denial.
• ACA §2719 external review — After an adverse internal decision, you may request an Independent Review Organization review. Confirm the exact external-review deadline on your denial letter; the standard window is approximately four months.
• Expedited review — If delay would jeopardize your health or ongoing treatment, request expedited handling at both internal and external review stages.

## Documentation to Gather

• Prescriber quantity-justification letter — Your immunologist should explain in writing why the prescribed quantity (expressed in clinical terms, referencing weight, diagnosis severity, and the FDA label's dosing guidance) is medically necessary for you.
• FDA prescribing label — Print the current label and highlight the section describing how dose is individualized. This establishes that the prescribed quantity is within the range contemplated by the approved product.
• Chart documentation of clinical response — Notes showing your clinical status, infusion tolerance, and any adjustments made to your regimen over time.
• Prior infusion records — If you have been stable on this regimen, records demonstrating that the current quantity has been clinically necessary and effective.
• Cigna coverage policy — Request Cigna's current policy for immune globulin therapy. Identify the exact quantity limit applied and address it directly in your letter.

## Criteria-Mapping Structure

Build a table that maps the clinical rationale for the quantity ordered against each element of Cigna's quantity-limit policy:

| Cigna Limit Parameter | Clinical Justification from Chart/Label | |---|---| | Frequency or volume threshold stated in policy | Prescriber's individualized dosing rationale with label citation | | Diagnosis severity qualifier (if any) | Chart notes documenting disease activity | | Any renewal or re-authorization requirement | Current clinical status and ongoing necessity |

Attach the FDA label dosing section as an exhibit and reference it explicitly in the appeal letter.