This is topic Insurance Question (BCBS vs Aetna) in forum Medical Questions at LymeNet Flash.


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Posted by brooke (Member # 16606) on :
 
We currently have BCBS and have been very happy with them, but are probably switching to Aetna at the end of the year. My question is, are they both the same as far as length of time you can be on IV's, certain antibiotics, etc? I really have no idea.

I just found out I have lyme and am only taking Minocycline so I haven't had to fight with anyone yet about extending the coverage or about the cost of a medication.

Just curious about how these two compare.

Thanks!

brooke
 

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Posted by gardenoflyme (Member # 9261) on :
 
I believe sometimes it all depends on the type of policy you have with each insurance carrier.

I have BCBS and had only a few problems and relatively great coverage. Paid for bicillin 100%.

My kids(who are graduated from college and have their own med coverage now) both have Aetna and their coverage is different. Both have the best policy their employer carries. Aetna is more restrictive based on the policies they have.

But I have been told by a doctor who is an acquaintance cardiologist that Aetna is easier for the DOCTOR to persuade to do something a little outside the norm.

Wish I had a more definitive answer for you.

Read the policies carefully!
 

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Posted by bettyg (Member # 6147) on :
 
check about PRE-EXISTING CONDITIONS ... lyme?

make sure all your t's and i's are DOTTED!!
 

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Posted by brooke (Member # 16606) on :
 
Thank you all for your replies. I will definitely call them and ask about pre-existing conditions. I didn't even think about that. BCBS will be $80 more per month but it's worth it to have all my meds covered.

Thanks again!

brooke
 

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Posted by seekhelp (Member # 15067) on :
 
Every policy is different, but I would say BCBS without a doubt. I have much experience in reviewing benefit plans. Aetna has VERY strict Lyme policies, especially pertaining to IV. I read them several months ago. If you're not CDC positive, FORGET it.
 

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Posted by TerryK (Member # 8552) on :
 
I have to agree. It will depend on the specific policy that you have but in general, I think Aetna is pretty restrictive from what I've heard. Don't know first hand.

Found this via google. YIKES!
http://www.aetna.com/cpb/medical/data/200_299/0215.html

Terry
 

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Posted by hanginginthere (Member # 11685) on :
 
Quick note--BCBS varies according to the state, with each state's policies differing.

Since I live in NC, my BCBS wouldn't cover any lyme treatment past two weeks. They're the ones who sued Dr. J

I see you're in PA. Hopefully, they'll be different there!
 

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Posted by brooke (Member # 16606) on :
 
Terry,

I saw that too but my brain is so foggy I couldn't comprehend what I was reading.

brooke
 

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Posted by herbalfrog (Member # 12711) on :
 
I have had BC/BS coverage for the last 12 years of Lyme's. They have always covered all IV therapy as long as I had it done in an infusion center at the hospital. I incurred some cost when I had in-home infusion the first time around.(about $1500)
 

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Posted by karatelady (Member # 7854) on :
 
Aetna wouldn't pay for my Igenex test for lyme. The reason?

There is no lyme in Georgia!!!
 

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Posted by seekhelp (Member # 15067) on :
 
OMG. that's ridiculous!

quote:

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Originally posted by karatelady:
Aetna wouldn't pay for my Igenex test for lyme. The reason?

There is no lyme in Georgia!!!

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quote:

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Originally posted by TerryK:
Looks like Aetna is VERY restrictive regarding lyme disease IV treatment and likely any treatment for chronic lyme disease.

It would be very difficult to meet their criteria if you are a chronic lyme patient. Looks like you must at least meet CDC criteria.

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You should see BC/BS-NJ's BS letter. They cut me off at 28 days. Aetna had allowed me 10 weeks.

It might depend on what you can/can't provide as evidence. ?? My experience with the two is that BC/BC is worse than Aetna in NJ with IV therapy.

My DH's company is switching back to Aetna so I guess I'll see how it goes.

I wonder if it depends on the doctor who reviews the claim on behalf of the insurance company? Maybe it's the luck of the draw?

I sure hope they hurry up and get that stinking IDSA guideline review done already!!!!
 

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Posted by TerryK (Member # 8552) on :
 
That's interesting ALiG. Their policy seems pretty cut and dried. I looked at the revision history of the document and I didn't see anything that looked like it had changed much since 2006. Did you get your treatment coverage through Aetna since then?

They do state that coverage will depend on each policy but the overall lyme policy seems pretty clear.

Did you have a CDC positive test ALiG? Or did they find borrelia in your spinal fluid? Sorry to grill you, I'm just trying to get a feel for how closely they stick to their policy.

HealthNet - through my husband's employer seems to have specific policies for each State. In Oregon, they refuse to cover most things related to lyme as far as prescriptions but CA seems more liberal. Perhaps it depends on State laws??

Before we signed up with HealthNet I tried to get info about what they covered as far as lyme and they pretty much wouldn't give me any real info. Hopefully Aetna will be different.

Shapiro stated on the radio interview with Pamela Weintraub that he feels there will be no changes to the guidelines as a result of the review. I sure hope that is not the case.:-( I'm tired of footing my huge lyme treatment bill.

Terry
 

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Posted by AliG (Member # 9734) on :
 
I did have IgM CDC positive prior to IV with Aetna.

I had a new CDC IgM positive and a SPECT consistent with Lyme & a bunch of positive co-infection tests going into this one with BC/BS-NJ.

They're insisting on either CSF proof or neuropsychological testing to prove active Lyme.

I'm not sure how they can require such things when one does not rule out the presence of Lyme & the other IMO is subjective.

LP is a risky procedure, not to mention I'm a needlephobe. If they could tell me it was 100% accurate I'd be all over it.

I had two separate specialists conclude that I still had active Lyme, where some jerk who doesn't even know me, hasn't met me or clinically evaluated me gets off demanding I be subjected to physical or psychological torture to have my benefits paid for is beyond me!

IMO - that equates to cruel and unusual punishment for being bitten & becoming ill.

I even had a physician Dxd Bulls-eye!!

BCBS insists that 28 days is enough, period.

edit to add: Aetna was 10-12/2007, just finished up BCBS partially covered Tx.
 

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Posted by TerryK (Member # 8552) on :
 
ALiG,
So sorry BCBS is being so awful. I would contact the insurance commissioner in your State and see what they can do to help.

With the bullseye and a CDC positive IgM WB, I don't see how they can make you jump through more hoops. I guess this is the chronic vs newly bitten debate?

How do they know you weren't re-bitten? I agree with you, how can they get away with this? Actually, if you push it, they probably can't.

arghhhhh!!!!!
 

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Posted by bettyg (Member # 6147) on :
 
ali,

check your state's insurance commissioner's web site out!


www.iid.state.nj

i used iowa's and then changed ia to nj; hope it works!
 

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Posted by brooke (Member # 16606) on :
 
Thanks to everyone who replied.

I guess I should have also mentioned that I use Express Scripts for my prescriptions. So I don't know if they make the final decision or if BCBS does. I'll find out more on Mon.

Thanks again!
 

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