)[This message has been edited by lou (edited 06 May 2005).]
Was on Rocephin for about 6 months.
Insurance didn't pay for ages -- at least a year. We were about to go to court, treating each refusal as a separate event (so they'd have to have a representative at court each time). Then insurance paid the supplier directly; THEN they called the supplier back and said, OOOOps, we didn't mean to pay you, can we have the money back (No).
Fight it all the way.
Lou's recommendation of the Lyme Times is an excellent one. There are forms to help you prepare insurance appeals, with the arguments well outlined. It is possible that Dr. Fallon's new study on retreatment in late stage Lyme may be helpful in your fight, but I don't believe it has been formally published yet.
You might also check through CALDAs intranet site, as they have many papers available that may be helpful for you. www.calda.intranets.com
scroll down and enter on the left side under "guest"
The other option to consider is whether you might qualify, somehow, for patient assistance. Technically it is available to patients that don't have insurance that covers the medication and whose income levels fall within certain parameters. These vary by manufactureor. (Forgive my spelling, it's too late! )
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Sonoma County Lyme Support
Am e-mailing my method to you, in the event it might work for you.
I don't know if you are aware of this or not, but next time, please use LOWER case not all caps when typing your text. It's considered shouting, and I'm sure you are desparate.
Also, you can EDIT your replies at any time! You can NOT edit the topic line...it stays as is so that's why it's important to be specific.
Also, please be as specific as possible in your TOPIC line; "have BCBS, how long do they pay for IV?" You will get many more answers since we have to pick & chose since there are between 40-50+ postings here daily.
Best wishes on your journey; I hope Lou or someone comes up with your solution!
Bettyg, Iowa
Interesting when we paid our BCBS payments in they went to Newberry Park, CA - the same place you are from! Mmmmmmmm......
I am having problems with the co. thta merged with your co.
They delay individual policyholders and other underwritten policyholders far more than self insureds who belong to large groups.
Check your state's insurance regulations, there may be something there that you can use to fight the dispute.
Also-this past week I started using a new tactic. The insurance co. was going to deny under covered services, they were going to claim that it was not a covered benefit. Six months earlier, I asked the ins co. for a written copy of their medical policy for my ins. policy. They wrote back and said that it was not available. Well, I've kept the letter for a rainy day, and I told the insurance company that I would forward their written denials and a copy of the letter about their inability to provide me with a copy of the medical policy, along with my comments and state insurance regulation to their analysts and to their major competitor.I specifically mentioned the name of an analyst who recently had commented about the insurance industry and caused the co.'s stock to go down a few points.
For some reason, they seem to have misplaced or decided against mailing that medical denial letter....
I am having problems with the co. thta merged with your co.
They delay individual policyholders and other underwritten policyholders far more than self insureds who belong to large groups.
Check your state's insurance regulations, there may be something there that you can use to fight the dispute.
Also-this past week I started using a new tactic. The insurance co. was going to deny under covered services, they were going to claim that it was not a covered benefit. Six months earlier, I asked the ins co. for a written copy of their medical policy for my ins. policy. They wrote back and said that it was not available. Well, I've kept the letter for a rainy day, and I told the insurance company that I would forward their written denials and a copy of the letter about their inability to provide me with a copy of the medical policy, along with my comments and state insurance regulation to their analysts and to their major competitor.I specifically mentioned the name of an analyst who recently had commented about the insurance industry and caused the co.'s stock to go down a few points.
For some reason, they seem to have misplaced or decided against mailing that medical denial letter....