I am about to go on IV abx and contacted the infusion company. They indicated that my insurance company generally will only approve 4 weeks of IV for lyme.
My insurance is U..ted HC. Not sure if I'm supposed to spell that all the way out but hopefully you understand which company I am referring to.
Does anyone have experience with this insurance company and IV meds?
Is there anything I can do or my doctor can do to request longer than 4 weeks?
If I have to pay out of pocket after 4 wks, do I have to pay out of pocket both for the medication and also for home health care? Is there anything I can do to avoid an exorbitant cost for home health care?
Thanks so much for any help you have to offer. My insurance company has been good in the past and had covered most orals without issue... even the expensive ones. I am hoping that the home health company has just been misinformed and that my insurance will actually cover more than 4 weeks.
V
Posted by sutherngrl (Member # 16270) on :
Unfortunately this is very common with most insurance companies. This is why so many ppl are on orals and not IVs.
You could do the 4 weeks of IV, then go to orals. Many have gotten well on orals and have never done IV.
Posted by VB (Member # 16824) on :
I have been on orals for 2.5 years, so was hoping IV would help.
Posted by janet thomas (Member # 7122) on :
IM Bicillin + biaxin or ketek + flagyl or tindimax is almost as good as IV.
An attractive alternative is benzathine penicillin (``Bicillin-LA''- see below). This is an intramuscular depot injection, and although doses are relatively small, the sustained blood and tissue levels are what make this preparation so effective.
Posted by VB (Member # 16824) on :
Yes, I was on IM Bicillin (2.4 MU/wk) and Biaxin for 18 months. I was doing well on it, but I developed a sterile abscess from the Bicillin, so for some reason my body stopped absorbing the medication and about 100ml of fluid and medication built up in my hip, which had to be drained. I then went to IM claforan into my thigh (I am small so this isn't ideal), which left giant bruises, and didn't help much. I seemed to backslide. Then switched to orals only, and I plateaued.
I was thinking IV would be what really would help me, and I basically have uprooted my life and moved in with my parents so I could live near a doctor who would prescribe it for me. Now that I've jumped through every hoop possible and am about to get the IV, I find that insurance may only approve 4 weeks of it. I'm not 100% sure about this... just heard this now on the phone with the home health co.
I am really frustrated right now with the whole thing and disappointed. I will pay out of pocket if I have to, but don't know how much of that I can afford, esp since I'm overextending my medical leave at work and will most likely be losing my job because of having to move out of state to live with my parents. Are there any inexpensive ways to do IV out of pocket?
Posted by kimmie (Member # 25547) on :
Interesting...I too have UHC. They only paid for 4 weeks of IV meds, but they did pay for the home health nurse and the 2 PICC lines I had placed. Now, I pay for my own IV meds myself. Once your insurance stops paying for the meds, you can get a prescription from your doc and just order your meds/supplies. I pay about $700/month for rocephin with all flushes etc.
Also, a family member can be taught to change your PICC line dressing. I taught my husband how to do it...it's not that difficult.
Posted by VB (Member # 16824) on :
Thank you kimmie. So will UHC continue to pay for the home healthcare even if they won't pay for the IV drugs themselves? Or is it once they stop paying after 4 weeks, they stop paying on everything... home health, supplies, meds, the whole thing?
Right now my LLMD is starting me with a peripheral IV, which I won't be able to do on my own each week so if that continues, I would need weekly home health.
Thanks again, Valerie
Posted by VB (Member # 16824) on :
I guess I probably need to start with the picc line at the beginning vs. the PIV then.
Thanks for the input everyone.
Posted by Tincup (Member # 5829) on :
![[Big Grin]](biggrin.gif)