Topic: Meidcare and Paying for IV Antibiotics. Yes there are IV Clinics!!!
springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Ok after months of asking and requesting and calling and trying to figure this all out...
I landed myself at an infusion clinic....
This is what I had been asking everyone everywhere .... if this sort of place exists after a nurse on this site told me it does and should.
But nobody every could point me to it.
I asked again when I was discharged from the hospital and they sent in a home health agency and I asked them about it.
They said yep there is one. So here i am.
Now I look back and see that I could have been doing this for a long time.
Medicare pays 100 percent.
SO when I get bills from Home Health .. which will be most likely only a percentage since I have secondary insurance..
Should I apppeal? I feel like I tried to go this route and there was nobody who could help me. I called even Medicare and I asked my doctors office and my secondary insurance and the other home health agency too.
Nobody knew of "such a place" as an IV clinic?
I guess its hindsight.
At the very least. For anyone else on here who does not know this and you have Medicare...
There are IV infusion Clinics and this one is open even til 8pm at night...
So.. Hey.
I hope at least this can save you some money ...
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
| IP: Logged |
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Good to know! Just sorry it wasn't sooner.
Sometimes you can go to the hospital and get the IV's daily.
Problem here.. they are so far away and if you are too sick to even get dressed or drive.. it is a problem.
springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Good Point Tin
For me too at one point this would not have been possible but there came a point it was and is and i sure do think people and insurance should be more forth coming with such information and resources.
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
| IP: Logged |
posted
It is very difficult to figure out our medical system, how to get access, how to get it paid for. I had a miserable time trying to line up home health agency which was totally inept. Even with insurance and a doctor's orders, they still couldn't arrange it.
Our system is sure not designed for sick people.
And is Medicare A or B paying for these infusion clinics and how do you find them? Questions that folks will be asking after they read your post.
Posts: 8430 | From Not available | Registered: Oct 2000
| IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
Is the clinic part of a hospital?
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
I get my IVIG at a Cancer Center. They have an entire infusion floor there.
I could actually get it at home now that I have completed my first week, but in all honesty, I have had bad reactions every single day and there is a doctor on site there, and I am at a hospital; I feel safer.
Furthermore, for me, who has been housebound and bedridden for a couple years, it is good for me to be forced out of the house five days a month.
Yesterday the doctor was not in, and because of the severity of my reactions, they actually admitted me to the hospital for the day/evening to be infused. They wouldn't do it in the Cancer Center without a doctor present. For me, that says visiting nurse at home is not an option.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
| IP: Logged |
springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Wow Tracy that sounds intense. Is that normal to have such a strong reaction.? What is it that happens when you take the IV?
I hope you feel better with it soon..
At first I thought the clinic was not part of the hospital because it had its own site and building. But today i asked more questions and they said they are part of the hospital and just got moved out due to room issues.
I do not get why the Hospital and Doctors push Home Health Services on you. They have on me. And it costs me much more and the way it is set up Meicare does not want to cover it. My secondary will but there are deductables and out of pocket maxes etc... And well.. I am not going to have to pay that much . I think 20 percent.. But over months that adds up.
The Hospital brought in a social worker who called a home health agency in. I asked (because I have asked so many people without a straight answer). If there was a infusion clinic that medicare will cover that i can go to.
It was the Home Health agency that finally admited to me that there was and they went back and got my social worker.
I agree it is good to be forced out of the house. Yes I was homebound too to the point that two times a day every single day and going to another clinic inbetween would have been very very hard. But as time went on and I was doing only IV in the home 1x a day I could have gone to the clinic and it would have saved me a lot of money there.
I think doctors should tell you your options and discuss them with you and make a choice together. I am not happy that the choice was not given or discussed and even I was told that I had no other choices..
Anyway..
So for those who have asked. It is part of the Hospital Services So Medicare Hospital Insurance is Covering the service.
I had them look up my doctors name even on the provider list and they did it right in front of them and there he was. They told me that he should have told me about them as well as an option and that is all they do. Infusions of ports and picc lines. ..
Not sure if there is some issue with contracts or money or deals going on.. I hate to think that.. but ....
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
| IP: Logged |
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Remember, though, that medicare typically will only cover treatment for lyme at a 28-day maximum.
Depending on how things are diagnosed, other coinfections being treated, how things are coded or what Rx are prescribed, some can extend this. But this can be cut off at anytime - they are not obliged to even go to 28 days, even with a doctor's orders.
You can never assume you will get the same service as another patient with the same dx and same Rx.
And, in those states where the state medical boards deny lyme even exists, be very careful. You may get no coverage or reimbursement at all.
Trying to ask about all this in advance is like asking if it will snow or rain 6 weeks from now. Usually, one is not told the truth and it also can send out red flags that get the doctor in trouble (again, mostly in those states out to deny lyme treatment altogether).
I had a couple months of rocephin donated to me. I tried to figure a way to have it administered to my but I live in the wrong state. Finally, I had to give it to someone in another state where she could get it administered.
I could not afford home health services, no doctor in my state would order that anyway . . . and had I taken donated Rx to the infusion center, I would not have been allowed to used donated Rx there - I would have to buy it from THEM.
Very sad. So, anyone exploring the routes to infusion, just be sure to have all the details for your state - and the individual centers. See it all in writing and still be prepared in case things change. -
Posts: 48021 | From Tree House | Registered: Jul 2007
| IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
thanks springshowers- does your LLMD have to be affliated with the hospital for this to be covered...do you know?
I do wonder if the reason it wasnt mentioned and home health is pushed on us (of which medicare will only pay if you are indeed housebound and Dr writes that on the order)
is that the LLMD's dont know... is that a possibility?
There must be a reason?
I live fairly close to many hospitals.. so would be fairly easy for me to go. I'm just not sure how I would go about finding a clinic/hospital in my area that would allow me to go there without my Dr being affilated.
I dont want to call medicare and alert them just yet...so dont want to ask them.
I am glad though that you wont have to pay to get your IV going further.
thanks for this info it is very helpful
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
Yes I realize it might be different for different people in different situations and states etc.
But someone had put this idea in my head months ago and told me to look for it and I had been asking and asking people without answers..
And then now I find myself there.
So sometimes just a little information and idea can help you on your own journey at some point in some way..
I heard you have to be certified as a doctor in the state your in for one and then I am not positive about whether the doctor has to be affiliated or not.? I know there are networks that doctors can sign up to be part of that contain certain services and locations. From what I understand. Maybe that is the same as affiliated? Not sure.
If I were you I would call the Hospitals in your area or look online at their sites and services. If you find they have infusion services call them. Ask them those questions and they can answer them to you directly. Then you are not calling medicare.
The thing is that right now my infusions are treating my Port Infection. So that is not a Lyme Diagnosis issue. But thanks for the information about the 28 day medicare rule. I did not know that either. That could be part of the reason?
Its all a mess.
Bottom line is we should not have a problem getting this coverage. I feel it is a doctors prescription and order. The other thing is some insuarnces consider it a script and some consider it a medical procedure.
So .. whatever...They need to get this all straightened out. Lyme patients are not the only ones doing Antibiotic therapy...
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
| IP: Logged |
Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
I had to search hospitals/infusion centers to find one where my doctor did not have to be on staff, because my LLD is two hours away. I found one, and it is the one where my PCP is on staff, and he had to OK it which was fine.
Bear in mind I am going for IVIG, not IV antibiotics. It is much easier to get approved, despite the fact it costs TEN THOUSAND dollars per day. My five day IVIG stint in the Cancer Center is $50,000.
I only go 5 consecutive days per month. I don't think I could handle going out every day. This is my first attempt at leaving the house much at all in two years....and today my body feels like it has been hit by a truck.
My side effects from the IVIG daily included high blood pressure, rash/flushing, panting/short of breath, rapid heartbeat, headache, neckache, stiff neck, back pain, dizziness, and then later in the night I wake up with severe back and leg pain. As of last night I've now been blessed with diarrhea too.
I think in fact I have everything listed except vomiting so far. They have to monitor me very closely and slow down the rate of infusion as soon as I start to flush/get the rash. I have to get it slowly.
Now even though IV antibiotics are what, two or three thousand a month, it is a breeze to get IVIG approved. I got six months of treatment ($300,00) approved overnight. And that is just my "trial period" to see if it is working.
Also, I had no problem getting IV antibiotics for lyme covered indefinitely with Medicaid, nor do any members of my family. Two are on them now, and have home nursing care covered.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
| IP: Logged |
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Tracy,
Can you say hho approved your IVIG? Medicare? Medicaid? Private Insurance?
thanks for the detail on IVIG. I looked into it years ago - it would have cost a fortune that I did not have as it was not available in my state then, maybe now.
I would have had to move 3,000 miles. I may revisit that now.
As for Medicaid covering ANY lyme treatments - everyone should know that can vary state to state and it likely not an option for those in states where their state medical board says there is no lyme
-- as Medicaid is run by each state and the state medical boards dictate what will be covered in their own state.
If one has a Medicare HMO, while Medicare is technically national, HMOs are state or regional and usually have distinct limits to coverage that can be different than what the basic national Medicare might cover.
From what I hear, the state of CT does allow treatment for lyme better than most states. -
Posts: 48021 | From Tree House | Registered: Jul 2007
| IP: Logged |
Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
Straight Medicare covered it no problem in the Cancer Center, CT Medicaid would have covered it at home.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
| IP: Logged |
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- That's so good to hear for CT patients.
It would be wonderful if a patient's "Bill of Rights" for lyme treatment (and all good medical care) were to be honored the same in all 50 states. -
Posts: 48021 | From Tree House | Registered: Jul 2007
| IP: Logged |
cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
Medicare covered the IVIG right?- i thought the post was about IV abx...did I miss something (a tad foggy today)
I think talking about IVIG in this post is confusing.
I am still asking if anyone knows how many days medicare will cover the IV in the hospital infusion department?
And is the reason that the LLMD's use homehealth because if you are homebound than medicare will pay for it longer?
I do not have medicaid so this is a Medicare question.
quote:Originally posted by Tracy9: Straight Medicare covered it no problem in the Cancer Center, CT Medicaid would have covered it at home.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[Big Grin]](biggrin.gif)
Printer-friendly view of this topic