LymeNet Flash: Another IV question

This is topic Another IV question in forum Medical Questions at LymeNet Flash.

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Posted by julielynne4 (Member # 20336) on :

I have been reading posts on IVs and it made me wonder who is actually getting their insurance company to pay for the port or picc.

I just started IV Rocephin after about 8 months of orals and I am getting neither picc nor port, as my LLMD just sticks my arm every time I go (about 3 times per week).

She thinks insurance would not pay for a port or picc and that is why we are doing it this way. However she said we can try to get approval for the port or picc, we just have to see if I herx right away because that would help our case.

Well no question about the herxing, I am in herxing hell right now. I am wondering if any of you are getting coverage for this, and if so, did you have a CDC positive ir Igenex?

Thanks everyone. Julie

Posted by Tracy9 (Member # 7521) on :

Medicare and Medicaid are both paying no problem

Posted by Tracy9 (Member # 7521) on :

Are you sure this is a reputable Lyme doctor? I never heard of getting Rocephin only three times a week.

Posted by julielynne4 (Member # 20336) on :

Yes, she is a reputable
LLMD.

She would prefer it if I had the IV every single day, however she is not close enough to my house for me to arrange day care and make daily trips. She believes this is the next best thing, although today when I go we are going to talk about me getting transferred to a local LLMD for my IV (to avoid the trip).

She does not think I will get coverage for a picc, especially because I am only positive according to Igenex. She tries to make treatment as reasonable as possible both financially and physically.

I would prefer to get a picc or port and get more frequent IV and my LLMD said we should give it a try to see if we can get coverage, so we will also talk about that again today.

Thanks for your help! [Smile]

julie

Posted by dmc (Member # 5102) on :

Have you or she even asked your insurance? Have you looked at your list of benefits?

I was only Igenex positive & everything covered by my insurance. All policies different.

Posted by WildCondor (Member # 434) on :

Why is the ROcephin only 3x per week? Sounds fishy to me. Insurance companies usually always pay for PICC lines or central lines.

Posted by julielynne4 (Member # 20336) on :

Well my LLMD is going to pursue the coverage thing for a port or a picc. I had an IV appt today so I was able to talk to her about it again...

Hopefully I will get it covered, but I know it is not that easy. I am not CDC positive, and I am only positive for coinfections through Igenex; I am not even technically pos. for Lyme itself although I had positive bands. Positive for babs, ehrlich., and bart.

It is only very recently that LLMDs cannot be harassed for treating chronic lyme - therefore my LLMD feels much more comfortable about pushing it with the insurance companies. In the past, every time someone put in for "questionable" coverage, it was a red flag and my LLMD would be called on it.

As far as 3 times per week, it is basically the best I can do unless/until I have a port/picc...it is ideal for me for now, because I am close enough to my LLMD to make several trips a week and I am already going through major herxing.

I know several people who have been denied coverage for IV and a port or picc EVEN with CDC positive results. A friend of mine continues to appeal his insurance company currently.

Oh btw I am also submitting all my payments for IV to my insurance and hoping to get reimbursed (they said they would pay for 30 days, we shall see if they do).

Thanks everyone!!! I appreciate your help and input!! [Smile]

Posted by Maryland Mom (Member # 2043) on :

I've had PICCs several times, each with a different group insurance. Every one of them has paid without question.

LLMDs have learned to use diagnosis codes other than that for Lyme to get treatment paid for. Lyme causes many other things, such as polyneuropathy and in many cases meningitis, among other things, that ins will pay for without the hassles a Lyme diagnosis often provokes.

Whether or not you've herxed on the Rocephin is good information for you and your LLMD, but will mean nothing to an ins company. They probably don't even know what a herxheimer reaction is, much less have guidelines on paying for treatment based on one.

Home health care companies usually are very helpful in setting up ins coverage. They make their living caring for people like Lyme pts on IV, so they know how to get ins to pay!

How about contacting the home health care company you would be using if you had a PICC or port, and see if they are willing to get in contact with your ins company about what they will cover?

Posted by Melanie Reber (Member # 3707) on :

It all depends on your policy. The quickest way to find out is to call the insurance company and ask.

Sometimes, only a certain percentage is covered with homehealth, supplies and surgery... while another percentage may be covered for the actual medications.

Your policy's fine print will spell it all out... however, be sure to read what their requirements are for meeting the terms of care and length of care.

Posted by Lisa1230 (Member # 17525) on :

Until you get approved for a PICC or port, why not have your doctor just leave the peripheral IV line in for you? This way you can infuse at home and save yourself child care fees and travel time.

My daughter can't have anything but the peripheral line and her stays in for up to a week then has to be changed.

At least you can do your IV meds everyday instead of only a few times a week.

It is a pain in the neck, but for us it is our only way to do this. Just a thought . . . .