My wife is doing IV doxy and so far a local pharmacy is billing to the insurance and they haven't said a thing about refusing payment. Now the dosage has to be up and I am getting nervous about the insurance payment. Her doctor's office also advice to check around before committing.
Even with Infuserve charging less compared to the local pharmacy, however, they need to charge first and help to file the claim to the insurance, while th elocal pharmacy would just send the medicine and directly ask the insurance for reimbursement, plus our co-pay.
I am wondering if I go ahead and use infuserve, it will raise a red flag for the insurance company to decline the payment, while the local pharmacy is all under the radar screen, and we might just be lucky for as long as we can.
I can't make up my mind what's the best way to approach this so I need all your bright minds to help me out.
Thanks.
Posted by Keebler (Member # 12673) on :
- Keep quiet about the diagnosis but, unless you can pay out of pocket, you should know what you are responsible for paying if insurance does not.
You do not need to disclose the diagnosis just to see if a certain medication and method of administration is to be covered.
If asked, say "it does not matter what the diagnosis it. Her doctor says this is needed."
Of course, most insurance companies make it very hard for the consumer to figure this out in advance of getting the bill.
Good luck. -
Posted by rmsfnc (Member # 27539) on :
shhhhhhh.
Posted by wtl (Member # 19883) on :
So should I stay (with the local and keep my mouth shut) or should I go (with Infuserve for lower cost if without insurance)?
I am tryint to not "blow the cover" and yet, I am trying to prepare for the worst...
Posted by sutherngrl (Member # 16270) on :
Go with local until you find out they won't pay anymore, then switch over to infuserve.
Posted by wtl (Member # 19883) on :
sutherngrl - That's sensible, obviously.
But I forgot to mention the dilemma comes that the insurance processes claims about 1 1/2 months behind schedule. So by the time we know they declined, we will be already at least 1 1/2 months into debt. By counting the price they quoted us, if without insurance, we are at $140/day, or something like that.
Posted by sutherngrl (Member # 16270) on :
Oh, I see your dilemma now!
Keep in mind that most insurance co's will only cover 28 days of IV treatment. This is pretty standard, I hardly ever see any Ins co cover for longer. That would be quiet rare.
Personally I would just do orals. I know many ppl that were cured by taking oral meds only. They are much cheaper and usually they are covered by ins.
Good luck! I hope you get lucky with your ins co.
Posted by momlyme (Member # 27775) on :
I have heard of insurance companies taking up to 3 months to let you know they are declining a claim.
So if the price is $140 a day compared to $?? (much less) a day with infuserve... I would make the switch at the end of the 28 days.
Posted by wtl (Member # 19883) on :
mom - thanks. If I was comparing $140 a day to $40 a day, it probably is a no brainer. But we are talking about $140 to something over $100 a day, it gets difficult. Either way, it's going to cost.
She has been on oral for a long time with nothing to show. And I hate to drop her like that - back to oral only.
I see her deteriorating everyday...
And there are so many other things I haven't even started her to try, that everyone has been talking about here...
Posted by momlyme (Member # 27775) on :
Have you confirmed that price ($100 a day) with infuserve? It seems high to me. I thought doxy was less expensive than rocephin?
We got rocephin (generic - ceftrioxone) for appx. $25 a day... that included dressing changes, heprin flushes, saline, etc - all the necessary supplies for a month.
Posted by sammy (Member # 13952) on :
wtl, please switch to Infuserve ASAP. You can have the prescription transferred if it is already on file at your local pharmacy.
At some point the insurance company will start to deny your IV antibiotic claims. I'm afraid that if you wait to long you will get stuck with a large bill. This is exactly what happened to me. Remember, I tried to appeal and lost, still owe around $9,000 for 7wks of IV Rocephin. I don't want this to happen to you.
You will have to pay upfront if you switch to Infuserve but they will file the insurance reimbursement claims for you. If your insurance continues to cover the IV's then you will be fully reimbursed. (Think, no copay!). When your insurance starts to deny the claims then you will not be stuck with the inflated price from your local pharmacy.
Posted by sammy (Member # 13952) on :
To your insurance company Infuserve is just another pharmacy. You should not be flagged in any way be switching pharmacies. You would only be flying under the radar if you payed out of pocket and did not try to submit an insurance claim.
Posted by seekhelp (Member # 15067) on :
Yeah, the insurance company will screw you w/o thought. Not worth the risk unless you're rich. Posted by wtl (Member # 19883) on :
mom - No doxy is a lot more expensive than rocephin. Yes, I did talk to Infuserve directly and got the quote from them.
sammy - thank you for the thought. I will write you an email about my thoughts on it so check...
I hope you find relief from enema. I read it in another thread but I have nothing to offer to help the situation. I can only offer hope.
Posted by wtl (Member # 19883) on :
![[Smile]](smile.gif)