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» LymeNet Flash » Questions and Discussion » Medical Questions » Daily IV Treatment and Insurance

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Author Topic: Daily IV Treatment and Insurance
Suffah
Junior Member
Member # 16461

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Hi,

I have been treated for lyme for 10 months and due to severe dizzy spells, lightheadedness and light sensitivity my dr wants to treat me with IV meds.

He wants to treat me daily with a butterfly infusion of Rocephin. Thing is my insurance will not cover this b/c my LLMD is "out of network".

Does anyone know a way to get around this without going the PICC or Port way?

thanks in advance!

suffah kate

Posts: 9 | From NY | Registered: Jul 2008  |  IP: Logged | Report this post to a Moderator
lostgurl
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Member # 19293

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This is subcutaneous infusion right? This is new, would have to be mixed with lidocaine even if IM or peripheral iv (or diluted with peripheral) so sub cutaneous - YIKES!

I have a port, and to be honest, I wouldn't do it any other way, but that's just me, i hear you on wanting to avoid it. If you can't, a port (in my opinion) is WAY better than a PICC

My infusion co. is one who specializes in Lyme and being advocates for us. Even though I have a local infusion co. I chose this one in Florida (y'all probably know who I mean) as they are out of network but granted me the in network rate to work with the insurance.

Your insurance should HAVE to cover this, most LLMDs are out of network and they KNOW this and are trying to pull one on you.


Appeal, get the MD to to a conference call with their med director, then appeal again, don't stop fighting. They work for you.. When there is no other local or in network option, they are obligated..

I know I speak really strongly on this one , but I worked and fought with insurance companies for years. I can't stand it when they try to screw us to be honest... See you got me going:)

Is it BCBS? They could be more tough, but still, fight like tooth and nail. You should by now have a Case manager assigned to you. She/he should be going to bat for you as well, even though they work for the ins., it's their job and they are really good people, they want to help you and get around this as best as they can...

Best of luck, keep us posted

Posts: 49 | From Louisiana | Registered: Mar 2009  |  IP: Logged | Report this post to a Moderator
TerryK
Frequent Contributor (5K+ posts)
Member # 8552

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I was on IM generic rocephin and had good results. I had to stop due to local reaction from the shots but you might ask your doctor about trying this instead of IV.

The cost would depend on your dosage and how often you get the shots but the cost for me was around $250 per month.

Take a look at your insurance policy to get some idea of your rights in your situation. Each policy is different.

Here are some links that might be helpful for dealing with insurance issues:
http://www.lymeinfo.net/insurance.html
http://www.lymedisease.org/resources/insurance.html

http://flash.lymenet.org/ubb/ultimatebb.php?ubb=get_topic;f=1;t=069819

Some of the links might be repeated.

Hope it works out for you.

Terry

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Lisa1230
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Member # 17525

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My daughter has to do the IV Rocephin the exact same way you are doing it -- everyday. She can't get a PICC line or port because she has a blood clotting disorder. Her lyme neurologist has a treatment facility right in his office which is run by his wife who is an RN.

This past week we got a call from the drug company that she was approved for the IV Rocephin everyday. I would guess that the doctor's office arranged everything with the RX company. The doctor told me it would be out of network, but something was done because it is being covered 100%.

My question is can anyone from the doctor's office do something for you? It is worth asking because sometimes they will find a way to make it work or another way to get it covered.

Posts: 51 | From Connecticut | Registered: Sep 2008  |  IP: Logged | Report this post to a Moderator
MY3BOYS
LymeNet Contributor
Member # 17830

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go over your policy yourself first.

just b/c md is out of network the meds prescribed should still be covered. i have run into this for yrs with rhum. i used, her visits were cash but ins covered rx.

now, have had 2 diff. ins companies since then and have not hade problem

do ur homework on peripheral iv's, esp rocephin

--------------------
i am not a Dr. any info is only for education, suggestion or to think/research. please do not mis-intuprest as diagnostic or prescriptive, only trying to help. **

dx in 08:lyme, rmsf, bart, babs, and m.pneumonia.

Posts: 422 | From TX | Registered: Oct 2008  |  IP: Logged | Report this post to a Moderator
   

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