IV antibiotics and insurance

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needshelp
Regular Member


Date Joined Aug 2008
Total Posts : 227
   Posted 1/4/2010 3:04 AM (GMT -7)   
I've been on IV rocephin (and oral doxy/biaxin) for 4 weeks.  My insurance (an anthem policy) approved the PICC line and rocephin for 1 month.  I would like to continue the IV and oral antibiotics.   Any suggestions on how I should approach this issue?  How long do they typically allow Lyme folks to do IV before they refuse treatment? 
 
Thanks,
Brad

bucci
Veteran Member


Date Joined May 2006
Total Posts : 1477
   Posted 1/4/2010 5:17 AM (GMT -7)   
Hey, I have to hop in on this question. is anyone out there on disability medicare and how are they paying for IV
hep c , lyme
Dad has lyme


CajunGrl
Veteran Member


Date Joined Mar 2009
Total Posts : 4717
   Posted 1/4/2010 6:27 AM (GMT -7)   
Brad,

Your doctor will probably have to write in to your insurance company and ask for an extension. He will have to tell them that the antibiotics are working but you are still having symptoms....or something to that affect. LLMD's usually know how to deal with insurance companies.
**You never know how STRONG you are....until being STRONG is the ONLY choice you have**

lymediseasethroughmyeyes.blogspot.com/

Co-Moderator Lyme Disease Forum


tickedoff
Regular Member


Date Joined Jun 2009
Total Posts : 56
   Posted 1/10/2010 12:30 PM (GMT -7)   
Hi Brad,
husband on iv antibiotics for 5 months now...only got covered for 28 days...dr. asked for extensions, denied...filed appeals within insurance co (empire) and finally an external appeal that is final...denied, i'm sorry to report...you should definitely file appeals and i hope you have better luck, but that is why the guidelines for treatment need to be changed...will be looking into social security disability as well...

needshelp
Regular Member


Date Joined Aug 2008
Total Posts : 227
   Posted 1/10/2010 2:19 PM (GMT -7)   
I've looked into this matter some (talking to other Lymies, educated nurses, etc.) and here is what I've found:
-Trying to get an extension (fighting with the insurance co.) can be risky.  In most cases it's probably not going to be worth while.  Although, if you are left with a huge bill after doing IVs it is probably unavoidable (for most of us). 
   
-According to a number of knowledgeful sources the insurance co. usually will pay for the first 8 weeks without too much trouble (although this can vary from one insurance co to the next as is the case with tickedoff).  After 8 weeks the risks go way up. 
 
The thing that I think is absolutely crazy (and should be illegal) is that my insurance co. (anthem) doesn't pre-approve IVs.  They pre-certify.  Basically, they can come back (after the fact) and refuse payment leaving me with a huge bill.  Effectively, I'm gambling that they will pay for my meds.  As a result, I will probably have my line pulled in 2-3 weeks.  It just seems too risky given my income and poor credit (as a result of this illness).  
 
It's really sad.....as I seem to be responding to IV therapy. 
 
My general impression is that if you cross the invisible line (when it comes to IV therapy) you can dig yourself into a huge hole financially and potentially create problems with the insurance co. that could cause additional problems later on.  

tickedoff
Regular Member


Date Joined Jun 2009
Total Posts : 56
   Posted 1/10/2010 4:37 PM (GMT -7)   
Needshelp,

believe me i totally understand the financial difficulties imposed on lymies with regard to the insurance non-coverage!!! but please, try to stay on the iv as long as dr. recommends...borrow from family, friends if you can...do whatever you have to...the best place i have discovered to get iv medication is infuserve...800-886-9222...they are wonderful...if anyone has found a less expensive company i would love to know...more than likely the insurance co will pay for the picc line per dr. orders...luckily we have some savings and family members have offered to help after that...fighting the insurance co was exhausting...i spoke to the office of the attorney general of connecticut...who fought the insurance companies in connecticut...and because of him in connecticut they cannot abandon a patient once treatment for lyme has begun despite the IDSA guidelines...there is a very good press release you can read on the attorney generals site...the really maddening thing is why we have to fight this state by state...insurance companies do not like AG Richard Blumenthal...who i believe is now going to run for Senator...maybe he will carry the fight to another level...hoping you find a way!

needshelp
Regular Member


Date Joined Aug 2008
Total Posts : 227
   Posted 1/10/2010 4:59 PM (GMT -7)   
tickedoff,
 
What are you doing about home health care?  This is a major expense (almost as much as the meds and supplies).

tickedoff
Regular Member


Date Joined Jun 2009
Total Posts : 56
   Posted 1/11/2010 6:30 AM (GMT -7)   
needshelp,

yes, you are right...have a nurse coming once a week $115 per week...you might be able to get someone for less if you ask around, (pay them directly) ...the nurse we have is very reliable and we didn't want to start with someone else who might not be as familiar with a picc line...what everybody in this country need to know is that we are all just one illness away from the poor house! especially lymies...my husband and i give thanks every time we do an infusion that we are able to have this medicine and we pray for those who are struggling...
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