Leelee
Frequent Contributor (1K+ posts)
Member # 19112
posted
My insurance company just told me that they will no longer pay for my IV Rocephin.
Does anyone know just how long the appeal process takes? Is it days, weeks, months? Just wondering what to expect.
Thank you.
-------------------- The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr Posts: 1573 | From Maryland | Registered: Feb 2009
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posted
It takes forever.... They took my insurance away for the IV Rocephin too. I never did get it back. Please check out hometech-rx.com My IV Rocephin and all supplies are under $25 a day now.
Posts: 303 | From green bay, wi | Registered: Mar 2009
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Leelee
Frequent Contributor (1K+ posts)
Member # 19112
posted
momofthree,
Did you leave your PICC line in while going through the appeal process?
-------------------- The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr Posts: 1573 | From Maryland | Registered: Feb 2009
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posted
I am still on my IV and still going through the appeals process. Found some good info on the use of CDC's surveying Lyme policy if you need it let me know.
Posts: 303 | From green bay, wi | Registered: Mar 2009
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posted
There is a pharmacy in Florida that supplies lyme disease patients IV antibiotics whose insurance company quits paying. It is called InfuServe America. I haven't purchased any Rocephin, but I have purchased IV PenG. They are pretty reasonable. I usually speak with Reenie about supplies and pricing. You need a script, and to prepay for the medication. They ship next day delivery also. http://www.infuserveamerica.com/Posts: 20 | From Washington, DC | Registered: Jun 2003
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posted
you may be able to get the drug covered with your precription insurance and mix it your self. You will need to buy the iv supplies separately.
-------------------- Dxd ALS 3/2010 Dxd cllinical Lyme 4/2010 Positive for Protomyxzoa but absolutely nothing else in Igenex Posts: 417 | From central ct | Registered: Apr 2010
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
I have been in the appeal process for over a year now (claims from 3/09). It has been an incredibly stressful process for me.
My insurance company initially said that they would cover my IV Rocephin. I received treatment for 3mo before they decided to pay only 4wks worth of the charges. I was left with a large outstanding bill.
I now have an attorney helping me, he's submitted the last 2 appeals. I have also had my congressman write a letter on my behalf. The insurance company seems unfazed. They continue to deny stating that treatment beyond 4wks is considered "investigational and not medically necessary". The Ohio Dept of Ins is now having my claims examined by and external review organization. This is my last chance.
My only advice to you is be persistent. You will need your doctor's help in submitting the evidence to support the "medical necessity" of your IV treatment (all your records and supporting research).
I would also recommend purchasing your IV meds and supplies from Infuserve. You have to pay upfront but they will submit the receipts to your insurance company for reimbursement. Sometimes your insurance company might pay for it this way when they refuse home health. Plus, Infuserve charges were cheaper than my home health copays! If I had known that from the start I would never ever have had home health care. I would have only purchased through Infuserve.
Good luck Leelee, you have a long road ahead of you.
Posts: 5237 | From here | Registered: Nov 2007
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Leelee
Frequent Contributor (1K+ posts)
Member # 19112
posted
Thank you everyone for your helpful responses.
LymeMomkellye, I am keeping my fingers crossed that you won't encounter difficulties with your insurance. I looked at the sample letters and I agree they could be very useful.
-------------------- The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr Posts: 1573 | From Maryland | Registered: Feb 2009
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