Now that the new guidelines passed, are you being denied
coverage? I'll mostly likely be prescribed some meds this week, and
am just wondering what I'm in for?
Posted by Lymetoo (Member # 743) on :
I haven't had any problems. Sometimes we are able to fly just under the radar!!
Posted by cactus (Member # 7347) on :
Most of my orals are covered by ins - sometimes with a higher co-pay than normal (due to the dosing, or something like that). Mepron was one of those, and my copay ran around $200 per month.
With a few exception like that one, most of the orals have been covered.
IV was another story - my ins only covered 30 days, everything beyond that was up to me.
I hope your ins will cover a lot of yours, too.
Posted by Beverly (Member # 1271) on :
So far my insurance has covered all of my scripts, even if at times, I have had to pay a higher co-pay.
Good luck.
Posted by lymednva (Member # 9098) on :
All mine are covered like any other rx. Posted by pab (Member # 904) on :
quote:Originally posted by adamm: Now that the new guidelines passed, are you being denied
coverage? I'll mostly likely be prescribed some meds this week, and
am just wondering what I'm in for?
We have HealthPartners insurance. We have not been denied any meds. You can look at your insurance's formulary to see what is covered.
Posted by listenswithcare (Member # 10719) on :
Mine have been covered in the same respect as my other prescription medications. The IV Rocephin was covered for 5 months (as long as my doctor and I thougth I should stay on it) too.
Robin
Posted by wiserforit (Member # 9732) on :
Hi -- oral abx are covered at the co-insurance rate; Malarone is not covered since the insurance company wants me to have Malaria in order to get coverage; Rocephin IV was a difficult fight.
With Rocephin I got 4 weeks begrudgingly and an additonal 4 with the warning that they'd never cover me for that medication again in my lifetime. Bizarre. Had to take out a huge loan for the other 2 1/2 months.
Best to you,
wiserforit
Posted by roro (Member # 13383) on :
i have been on oral abx for three months now and so far covered
Posted by tdtid (Member # 10276) on :
Another one jumping in here that also has been covered by insurance. Have only done orals though, so haven't tested the limits with other avenues.
Mepron, my most expensive is running me about $60 a month and considering it's not a cheap drug, I don't complain.
Cathy
Posted by djf2005 (Member # 11449) on :
i think i have the best ins possible.
my cost for oral are 5 bucks
other meds like mepron are 30
and iv was covered for 3 months
iv now is on my own, still, i was and am blessed.
thank god!
Posted by hatpianka (Member # 12244) on :
So far everything has been covered. My insurance is interesting in that after I hit $1,000 in prescriptions, I have to pay full price and then I get 80% back.
Before I hit the $1,000, co-pay was as low as $3 for generic meds. Unfortunately I hit the cap really early in the year (mepron put me over the edge).
Posted by CaliforniaLyme (Member # 7136) on :
Mine covered no problems now*)!*)!! Yes, covered with no problems*)!*)!*)
When I needed IV Rocepihn years back- heck no*)!
Posted by lahines65 (Member # 11027) on :
My doctor starting complying with the insurance companies and after 4 weeks of i.v. rocephin he wanted mr to discontinue (per the new guidelines). I paid $875.00 for one more week and then had my i.v. pulled. My doctor put me on Augumentin and Flagyl and insurance covered that but I got worse!
Now, I'm doing HBO and going to start Vit. C/ Salt Solution.
If this doesn't work I will need to find a new doctor who is willing to fight with the insurance co.'s for his patients. My doctor is tired of the politics and not getting paid.
Posted by bettyg (Member # 6147) on :
been on orals only
i pay up to $250 max; rest are 100% paid
last year i had that paid in MARCH; 9 months of free meds! Posted by TerryK (Member # 8552) on :
My oral prescriptions are paid for just like they would pay for any prescriptions. I think IV abx will be a problem for me though. They only pay for one month anyway according to the policy.
I think there is a disconnect between medicare prescription coverage and diagnosis at this time because they are separate policies and the only time a diagnosis comes up is when you need coverage for a drug that is not on the formulary.
I expect they will eventually get that figured out at which time there may be more trouble getting prescription coverage for lyme via a medicare prescription policy.
Terry
Posted by sonicbmx (Member # 12949) on :
my insur (SAG/BCBS) uses Medco.. it costs me $75 for a 90 day supply of whatever the ordering Dr requests. i just have to make
sure the Nurse and/or office Nazi check BRAND ONLY. what a pain that is.. that's a whole nother can of worms! -- sonicbmx
Posted by randibear (Member # 11290) on :
so far my office visits and meds have been covered. however, hey did mail me a letter stating they were putting me on a "high risk" listing.
grrrr.....
Posted by savebabe (Member # 9847) on :
Most of my meds are paid for, and the others I had to get pre-authorization.
Luckily, I have had no serious conflicts with my insurance company.
![[Big Grin]](biggrin.gif)