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» LymeNet Flash » Questions and Discussion » Medical Questions » What are IV/PICC costs with insurance?

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Author Topic: What are IV/PICC costs with insurance?
coltman
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Does your insurance covers it? how much is copay? Have you ever been denied meds ? So far I havent encountered any denials - but I havent it really used either . I am positive on WB (labs done trough quest) dont have ELISA done though - does it matter?

Also my llmd will be most likely out of state ad out of network, how do people get PICC lines to be covered under insurance?

I have BC/BS HMO and will switch to PPO once my company allows it (they only allow once a year).

Posts: 856 | From MA | Registered: Jul 2009  |  IP: Logged | Report this post to a Moderator
sammy
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My family doctor ordered my PICC at a local hospital so that my insurance would cover it.

Cost will vary depending on where you have it placed. Call around to local hospitals, they should be able to give you a price. Your copay will probably be around 20% but that can vary too so check your benefits.

Coverage for the actual antibiotic infusions and supplies will also vary plan to plan. Again you will need to check with your insurance company to see what exactly is covered under you plan.

If you have to pay out of pocket one month of Rocephin and supplies will cost you around $1,000 although i've heard some people have been able to cut that down to about $600 per mo. This does not include nursing care so you will have to find someone to help you will dressing changes and such.

I am currently going through the appeal process for IV coverage. It's not fun. Best to get everything worked out before you start.

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sammy
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One more thing, even if your insurance covers the IV infusions you might still have a copay. Check into that.

My copay for 1 week, yes I said 1 week, of IV Rocephin through the home health agency was $276! Wish I had known that before I had racked up 3 mo worth of bills. My copays are more expensive than paying out of pocket and bypassing insurance!

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kimp
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We didn't have an issue w/ insurance covering PICC line insert; only $10.00 co-pay.

No co-pay on IV antibiotics but they would only pay for 1 month. WE were doing IV zith and insurance was paying about 600 per week for antibiotic & home health.

Tried the appeal process and got no where.

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sammy
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You only had to pay $10 for your PICC insertion? That's unbelievable! My copay was over $600 for placement. Wow Kimp, I wish I had your insurance plan.

Coltman this is a great example of how insurance providers and plans vary. Check your out carefully.

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kylasrain
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I have BC/BS PPO and they have denied all IV antibiotic treatment. I tried to get a pre-auth to no avail. I plan on appealing, but know it might prove fruitless.

I got a deal through a home health care solutions company where I mix the Cefaxtrione (sp?) myself for $750/mo.

The catch is then you also need a home nurse to change your dressings once a week, etc. This can set you back up to $200/week. See if you can work a deal out with a nurse locally where they don't have to drive far to see you. I have a friend who is an RN who's going to help me. I'm lucky!

I have no idea what the PICC is going to set me back...I just got it 3 days ago. I'll let ya know....

Keep us posted =)

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coltman
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Bump - please some more IV/PICC insurance experience needed. I start thinking if I cant get IV abx covered by insurance LLMDs are not worth it ( I mean I ll have to pay LLMD fees on top of the iv /picc cost? - no way I can afford it if insurance wont cover it)
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Nancy2
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You can use your Visa or Mastercard. That is what many of us have done to get by with the costs!
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keltyl
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I have ppo bc/bs, and I guess they will pay for 28 days, then I'm on my own. I have found out that the same ins varies from state to state, and I thought NY was one of the worst.

I have been in contact with Infuserve and some other companies, but I'm at the point now that I am totally confused.

Kylasrain, if you pm me I can try to tell you what I've found out so far.

I would also greatly appreciate some feedback from other with experience.

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22dreams
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Atena HMO will ONLY cover IV abx in part if the patient presents with pretty severe neurologic and/or heart involvement or failed improvement of lyme arthritis with orals; BUT must have:

1) positive ELISA or spinal fluid;
2) followed by a positive CDC western blot

so, IOW, the hand of God will pretty much have to come down and interfere for most lyme patients with this company so that we'll test positive with the "two-tier" CDC surveillance testing.

I definitely need IV and have to look into OOP (out-of-pocket) options as well. No nurse friends......

oh yeah, and I think I remember reading that once a person is diagnosed with MS under this plan, they will NOT pay for further lyme tests.

Like MS patients can't get bitten by ticks and contract lyme...?

maybe I remember it wrong, but I would swear that is what it stated.

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TerryK
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colt - you may not need IV. That will be a decision that your LLMD will make. If you read the ILADS guidelines, you will see that orals are used. Many people get great improvement with orals alone.

Some of the co-infections are not treated with IV so even if you can't get IV, it is worth it to see an LLMD and get whatever treatment you can get.

Every insurance company is different and each insurance company has many plans so no one here will be able to tell you if your particular policy covers IV. You will need to look into that yourself.

If you are denied, you can appeal. Many people don't and that is what the insurance company is counting on. Much cheaper for them. There is a Lyme Times publication specifically dedicated to insurance. You can order it from the CALDA site.

I'm going through this myself - trying to figure out how to pay for IV but I have had significant improvement on orals. I've been infected for decades though and really need IV for penetration.

It may eventually be easier to get IV. I don't see how the IDSA can keep their recommendation based on their interpretation that long term IV does not help in light of DeLong's presentation at the IDSA hearing.

Can't wait to see what comes out of that.

Terry

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alliebridge
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I had BC/BS of MA, PPO and they covered my three rounds (of 28 days) of IV abx plus visiting nurses' visits.

I agree with Terry that you may not need IV.

If you have neuro symptoms I'd recommend it, though.

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hezzer926
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There is a lyme net member I recently spoke with who is under success stories .. she said she had only orals and is at 100 percent .. she had mostly neurological sxs
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alliebridge
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I have mostly neuro symptoms and I only started seeing improvement on IV abx.

So, although this one success story with orals/neuro symptoms is great to hear, I'm speaking from my own (and my sister and many others here)experience with oral abx and having neuro symptoms.

I was approved for SSDI this year even after having been on oral abx for three years.

Just started IV this year and would HIGHLY recommend it for anyone with neurological involvement.

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swachsler
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A lot of Mass. ppl on this thread!

Colt, any chance you're eligible for MassHealth?

I've been on Medicare and Masshealth for years, so I don't know what private insurance tends to cover or not. When I had Tufts HMO, it was a NIGHTMARE.

There are a lot of different health plans offered by the Commonwealth now. Don't know if it's possible for you to get on one...?

Good luck. I get my PICC this Monday. I'm having a consult with LLMD about it tmw. Soooo anxious.

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heiwalove
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hi sharon! how many months of IV did medicare and masshealth approve for you? i have a dear friend in MA who receives masshealth and medicaid (i think) and they only approved 2 months IV, and even that was a huge hassle (& she's severely neurologically affected). i'm amazed you haven't had any trouble getting meds covered for long periods of time!

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