I'm looking for health insurance companies that WILL cover IV antibiotics for Lyme Disease.
Can anyone please help me find them?
I may be losing my current health insurance in a little over a month.
Once I loose it I will be eligible for a HIPAA plan.
That means I get to choose from HIPAA plans offered by any health insurance company in California (where I live) that offers individual insurance plans.
The most important factor in my decision of which insurance to get is which plan will pay for my IV antibiotics for Lyme Disease.
I'm currently on Rocephin, and my doctor is considering Zithromax and possibly Clindamycin and Avelox (moxifloxacin).
Were I to pay out of pocket for these drugs, the monthly expense would probably dwarf any monthly health plan premium.
So finding a company that will pay for the IV antibiotics is my biggest concern.
Does anyone here have a health insurance plan or know of one that covers IV antibiotics for Lyme Disease?
Even if you have to have the drugs paid for by some abnormal process despite an official refusal?
(that's how I'm getting them paid for right now)
Does anyone have any recommendations or stories to tell?
Thanks everyone for all your help!
Cheers, Justin
(Crossposted on LymeFriends, LymeLand, Twist of Lyme)
Edited for clairty. Thank you bettyg for your advice.
[ 09-02-2009, 02:17 AM: Message edited by: Justin8448 ]
Posts: 4 | From East San Francisco Bay, CA | Registered: Sep 2009
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posted
One idea I thought up is to call specialty pharmacies that provide IV antibiotics specifically to Lyme Disease patients and ask them who they are able to get reimbursements from.
Two pharmacy companies assisted me with this question, others did not.
I won't say who I called because I don't want them to get into trouble for giving this information out.
Unfortunately for me I think the top two insurance companies are for federal employees only.
Here are the results:
GHI - One pharmacy says GHI pays for everything, pretty much indefinitely.
Geha - The other pharmacy says Geha (GEHA?) is the best.
Healthnet - One pharmacy says they have some success with Healthnet.
First Health Network - One pharmacy says First Health Network pays for a while longer than one month, but not forever. The other pharmacy says they sometimes pay.
Federal Blue Cross / Blue Shield - One pharmacy says Federal BC/BS pays sometimes.
Blue Cross - One pharmacy said Blue Cross is very inconsistent. The other pharmacy just said they never pay.
Aetna - One pharmacy said Aetna never pays.
United Health Care - Both pharmacies say United Health Care never pays.
[ 09-02-2009, 02:17 AM: Message edited by: Justin8448 ]
Posts: 4 | From East San Francisco Bay, CA | Registered: Sep 2009
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bettyg
Unregistered
posted
welcome justin
sorry, i couldn't read majority of your post. would you edit both of your posts and break them up into SHORTER paragrahs and DOUBLE SPACE between each paragraph.
use my guidelines below ok will help us severely neuro lyme folks be able to comprehend and read them.
also i suggest you show CALIF. in subject line when you edit your post; then you grab calif. folks' attention.
fyi, from what i've most cover 1 month ONLY! ---------------------------------------------
Welcome; I'm so glad you found us!! You've come to the right place for education and support!
Betty's suggested POSTING GUIDELINES . many of us have neuro lyme where we can NOT read long solid block text and be able to comprehend and read it as is.
please edit your post by CLICKING PAPER/PENCIL ICON to right of your name. that opens up BOTH subject line and body text.
now please break up your WORDY SENTENCES into one sentence paragraphs. Then hit ENTER KEY ``TWICE`` after each paragraph; we need that space for comprehension.
then go to left hand corner and mark box to receive ALL REPLIES, and click EDIT SEND
we thank you for helping us; otherwise, we will SOB, SCROLL ON BY, since we can't read to help you. If I see posts like this, I SOB them; to hard on me. ------------------------------------------------------
People seeking doctors might be able to get help from their state online information and support group. Nearly 3,400 people belong to state groups. Some of the groups are small but more than 20 of them have 50 or more people and seven have over 100.
The groups are moderated and you have to apply. Most don't allow doctor names, but once on the group, you can ask for doctors in a certain area and ask people to email you privately. *******************************************
This explains the medical politics around lyme WHY you need an ILADS-educated or ILADS-member LLMD (and there are also some ILADS-member LL NDs (naturopathic doctors):
You should also be evaluated for coinfections. Not all tests are great in that regard, either, but a good LLMD can evaluate you and then guide you in testing. One of the top labs is:
"With most infections, your immune system first forms IgM antibodies, then in about 2 to 4 weeks, you see IgG antibodies. In some infections, IgG antibodies may be detectable for years.
Because Borrelia burgdorferi is a chronic persistent infection that may last for decades, you would think patients with chronic symptoms would have positive IgG Western blots.
But actually, more IgM blots are positive in chronic borreliosis than IgG. Every time Borrelia burgdorferi reproduces itself, it may stimulate the immune system to form new IgM antibodies.
Some patients have both IgG and IgM blots positive. But if either the IgG or IgM blot is positive, overall it is a positive result.
Response to antibiotics is the same if either is positive, or both. Some antibodies against the borrelia are given more significance if they are IgG versus IgM, or vice versa.
Since this is a chronic persistent infection, this does not make a lot of sense to me. A newly formed Borrelia burgdorferi should have the same antigen parts as the previous bacteria that produced it.
But anyway, from my clinical experience, these borrelia associated bands usually predict a clinical change in symptoms with antibiotics, regardless of whether they are IgG or IgM." ===========
ILADS The International Lyme and Associated Diseases Society (ILADS) provides a forum for health science professionals to share their wealth of knowledge regarding the management of Lyme and associated diseases.
UNDER OUR SKIN dvd LYME DISEASE documentary, www.lymediseasefilm.com go to this site to view trailer of UNDER OUR SKIN 5 min. Clip! Premiering 2008!! on big screen 09 in 10 LARGE CITIES ONLY!
please get a western blot igm and igg blood test drawn LOCALLY on a mon. or tues. and sent to the below ok! all details are there.
IGENEX , CALIF. BLOOD TESTINGS ...check current $$!
* Please note: What you are about to read below is NOT meant to scare any of you from any lyme testings done; it's meant to be informed PRIOR to going into having various tests done and then be told what the costs will be! * Mine was sticker $$ shock on various testings done by my 2nd LLMD/new to me in 4=06. Those tests/results are found elsewhere in my links/advise.
* Igenex's charges for these below things cost $905, which I figured up the last 2 days for 2 other folks includes
* The below tests were done for ME; you MAY NOT NEED them all ok! :
* western blot IGM & IGG, this is MANDATORY for you which costs $200 total for 2 tests done; 6.09 same prices still. * * ******************************************************* * OPTIONAL ONES ARE:
* co-infection panel for YOUR AREA OF COUNTRY; * PCR WHOLE BLOOD...this is what my LLMD ordered!
It's PREPAY! unless you are on medicare; IGX will file the paperwork & it's FREE to you.
go to www.igenex.com and read over their info. Prices go up twice a year: MAY and NOVEMBER!!
* * have blood drawn MON. or TUES. only; you don't want your blood sitting in post office over the weekend; will ruin the results!
* Also, call 1-800.832.3200 for CURRENT PRICES! * They will also send you a ``test kit'' with their required form, all the test vials, & box to ship it in! OUT OF USA will take longer to receive!
* You need to DOWNLOAD IGENEX's required form.****************************************************** * * MD, DO ,ND, AC, DC are all fine** must sign, date, and show DIAGNOSIS CODE on there why he's ordering the test.
Make sure you show to FAX results and SNAIL MAIL PAPER COPY! My results were lost for 4-5 weeks! Bettyg * * When you get your results, please post them in MEDICAL; * Post ONLY the POSITIVE & IND ones .... not the negative ones!
GET COPIES OF ALL YOUR SPECIAL BLOOD TESTS: western blot igm/igg and/or co-infection tests always!!
* Also, look for post by LYMETOO/TUTU on DR. C's (Missouri) explanation of the western blot IGM & IGG numbers, below!
posted
It isn't just what insurance company you are with. It's what drug plan you have.
Posts: 991 | From California | Registered: Feb 2006
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posted
I have Aetna, and they have paid. They covered my Rocephin for three months, plus all supplies (saline flushes, PICC line dressing changes, etc.) They were calling me every month to see if I was ready for a refill. Copay was $120.00.
This was with a large group plan, I don't know about individual plans. It does make a difference.
Posts: 374 | From United States | Registered: Nov 2008
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Lymedad - Did you get the Rocephin from a pharmacy directly linked to your pharmacy coverage?
Or did you get it from a company that supplied the homecare and IV supplies too? Could you tell me which parmacy?
I'm looking into United Heath of CA as a possibility right now. Thanks!
Snailhead - Thanks for your advice about Aetna.
I have Aetna too right now and they actually pay for all my Rocephin as long as I get it from their specialty pharmacy and it is billed to my pharmacy coverage.
If I tried to get it from a company that also supplied the homecare and IV supplies it would be billed as a medical expense and probably be denied.
I'm worried that if I try to switch to Aetna's HIPAA plan there is a chance I won't be able to get away with this trick anymore, so I'm soliciting advice.
Jblral - I agree, which pharmacy coverage you have really matters a lot!
I've found out by calling several insurance companies that many don't even have Rocephin and other IV antibiotics in their formulairies. Doh!
Thanks again everyone!
Justin.
Posts: 4 | From East San Francisco Bay, CA | Registered: Sep 2009
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