I've had my PICC line for about 2mo now. On IV Rocephin. Was told that my ins did not require precertification for IV antibiotics.
The infusion company contacted me today. My ins company has not paid for anything yet. They have not sent me any EOBs, requests for more information, or denial letters yet. They are in the process of reviewing the request for payment.
Please please pray that they (Anthem BC/BS) will cover the Rocephin that I have received and continue to cover the treatments that my doctor recommends in the future.
I have just recently started to notice some improvements especially with my neuropathy symptoms. It is giving me hope.
I am single, barely (by the grace of God) working part time to try to cover my medical expenses. Even still I come up short each month. I cannot afford to pay for Rocephin out of pocket (and I don't have any wealthy or generous relative to help).
Please pray that God will continue to provide for me and that His will will be done in this situation.
Thank you all so much for your love and support:) You all are the only ones that understand. Thank you for caring and thank you for praying.
[ 06-22-2009, 10:21 PM: Message edited by: sammy ]
Posted by mtree (Member # 14305) on :
Oh Sammy...
I am sooooo sorry you are going through this....
I will pray! to have to worry about insurance
hope things get a bit better... mtree
Posted by feelfit (Member # 12770) on :
prayers sent (((((sammy)))))
Posted by Ocean (Member # 3496) on :
Ditto!!
Ocean
Posted by Lymetoo (Member # 743) on :
quote:Originally posted by sammy:
Please pray that God will continue to provide for me and that His will will be done in this situation.
Done! I'll pray everytime I see your thread here, OK!?
I'll bet everything will work out!! Posted by bettyg (Member # 6147) on :
sammy, sending you my prayers your insurance co. will pay without giving you a hard time. Posted by lou (Member # 81) on :
Hope you have someone to help you with appeals, should they renege on you. Anthem does not have a good record on IV for lyme. It sometimes happens that they refuse to pay after a patient has run up big bills. The fact that preauthorization was not necessary does not mean they still can't use the old excuse of "not medically necessary."
There are cheaper ways to do infusion than your local infusion company, which is going to be charging top dollar.
Posted by sammy (Member # 13952) on :
Thank you so much for your kind words of advice and prayers. I cannot even tell you how much of a comfort you have provided me. It is good to know that i'm not alone in this.
Still no word from the either the infusion company or Anthem. I'm taking this as good news, there is still hope.
I just have to keep reminding myself not to worry. I've already given this up to God and I do not need to take it back!
Thanks again:) You all are true friends.
Posted by bettyg (Member # 6147) on :
sammy, that's what friends are for and especially on this SUPPORT forum! Posted by aklnwlf (Member # 5960) on :
You're in my thoughts and prayers Sammy!
I know when I start to worry about things I always tell myself that things will work out the way that God wants them to and for my own good.
Sometimes we don't see things working out for our own good but in the long run they usually do.
Hang in there!
Posted by Lymetoo (Member # 743) on :
Still praying, sammy!! Posted by Dekrator48 (Member # 18239) on :
I am praying that God will guide everyone to work this out, so you will not be burdened.
Posted by MorningSong (Member # 19989) on :
Sammy~
Praying too for Gods special grace and that He will fight for you and show Himself mighty on your behalf.
I too am on Rocephin and have Anthem insurance.
Posted by Tincup (Member # 5829) on :
Prayers for you dear sammy.
Posted by seekhelp (Member # 15067) on :
Hope it works out for you Sammy. I almost fell into that trap when my ID doc Rxed IV meds. Fortunately, I worked in the medical benefits area and pushed hard to make BCBS tell me they truly don't issue pre-certs for IV meds. I knew they'd burn me in the end. That's BS on the side of the infusion company. A lot just want to make a $$$. They know better.
Posted by sammy (Member # 13952) on :
Thank you all for your words of encouragement and prayers. I've been wanting to give you an update but until today i've had no new information to share.
I just received 8, yes 8, identical letters from Anthem today informing me that they have requested information from my doctor and will begin processing my claims after the information has been reviewed.
So if you will, please continue to keep me in your thoughts and prayers. Thanks so much!
Posted by Zebco 33 (Member # 18376) on :
Sammy, I am keeping you at the top of my prayer list. Remember, your never alone as long as all of us are here thinking positive thoughts for you.
Keep your eye on God while the storms of insurance and illness swell under your boat.
When things go really bad for me and I freak out, (daily), I remember to keep my focus on God's eyes. He will bring you to where you need to be and give you what you need.
Doesn't insurance SUCK. Mabye that's why Jesus perfromed miracles when he walked the earth. His insurance company wouldn't pay for treatment!!!!
I'm a dork
Posted by bettyg (Member # 6147) on :
sammy, thanks for update. 8 IDENTICAL LETTERS; what a waste of trees per patient!!
also go to thought for a day, i put a wonderful thing on there a little while ago; meaningful words and great soft music! Posted by sammy (Member # 13952) on :
Update 5/20/09
I talked with Anthem today. They still have not received any of the information (H & P, medical diagnosis, hx of persistent- huge list- of symptoms after 1mo oral treatent, etc...) that they requested. They faxed the letter of request on 5/12/09.
I explained my situation to the representative and was told that it would about 7days to process the information after it was received. She was very nice but could not help me one bit.
So I called an left a message on my LLMD's nurse line to make sure that they received the request, asking that they please submit the information asap, and asking guidance on what to do in the mean time.
Backtracking a little bit, the infusion company contacted me yesterday. Since Anthem has not paid for my first 2mo worth of treatment, they are going to hold my medication until it is approved and paid for.
So, as of today, it looks like I will not be receiving any PICC supplies or Rocephin for this week.
The "care coordinator" from the infusion company also called Anthem and my LLMD's office yesterday to try to expedite things but it doesn't sound like she got anywhere.
So if you would please be so kind to continue to keep me in your thoughts and prayers. I would greatly appreciate it:)
I would just hate to have to stop treatment now because I feel like i'm actually making progress on the IV Rocephin. You all are the only ones that understand.
Thanks again
Posted by bettyg (Member # 6147) on :
sammy,
what a bunch of jerks! i'd like to spank their behinds .... Posted by sammy (Member # 13952) on :
Another UPDATE 5/20/09
So I had to go to work at 1pm but the saga continued. After the phone calls were placed at home, I started to get called back while at work (big no no, my work doesn't like private calls). Thankfully my coworkers were kind enough to cover for me even with our insanely crazy schedule today.
I found out that my LLMD did not receive the letter from Anthem requesting information. So I had to make more calls and get that taken care of.
Infusion company was not willing to work with me so LLMD had to call in an RX to another pharmacy (Infuserve). My doctor did not want me to take any time off while getting this settled so I will have to pay cash for at least this weeks worth of Rocephin.
The last person at Anthem was not very friendly at all, I asked if there was any way to expedite the process to get the claims approved. She said "no, they have at least 30days to process the claim".
So, in the end I will be continuing my Rocephin treatments this week. But will have to pay out of pocket for it:( And Anthem continues to drag their feet. Hopefully my LLMD will get the info requested in soon so that they can process it ASAP.
Bettyg and Zebco, thank you for the laugh. I really needed it today:)
Posted by Lymetoo (Member # 743) on :
OH man. You need lots of prayer still! That stuff is SOOOO expensive!!!
hang in there!!!
Posted by bettyg (Member # 6147) on :
sammy, i'd ask to talk to the supr.; they turn you down; ask for their SUPRS. NAME/PHONE NO./EMAIL and keep going up the rank and file.
i talked to 1 of bcbs many VP of it's des moines, iowa HQ once. "how did you get this number and my name"!
actually called for another one who gave me his personal card at a community meeting discussing issues.
"anytime you have a problem, call me"!! so i did but he was gone, so they referred me to ANOTHER VP.
she didn't get any quicker action and FOLLOW-THRU than i had! Posted by sammy (Member # 13952) on :
Update:6/22/09
After getting my HR department at work involved, I finally found out that Anthem has uploaded my information to the claims department today. (It's only taken over a month to get this done!)
Now the auditor will have 7-10 days to make a decision as to whether they will pay or not.
Dear friends, please keep me in your thoughts and prayers this week. This issue is weighing heavily on my shoulders. Please pray that God will continue to provide.
Thank you all and God bless!
Posted by bettyg (Member # 6147) on :
sammy, you're in my prayers, and thanks for the update! xoxox
Posted by Gerifrog (Member # 17990) on :
_ Prayers said.
Fingers & toes crossed too!
Geri -
Posted by Ocean (Member # 3496) on :
Ditto,
Please let us know how it goes, this has to be so stressful for you.
As a side note, are the IV meds helping you???
Take care, Ocean
Posted by sutherngrl (Member # 16270) on :
You are in my prayers! No one should have to worry about this kind of stuff when they are ill.
Posted by sammy (Member # 13952) on :
Thank you Betty, Geri, Ocean, and Sutherngrl!
I've made the most progress with this combination of meds and IV Rocephin. The biggest improvements have come over this past month/month and a half.
Even my coworkers have noticed a difference lately. This is huge because some of them didn't really know that I was so sick. I've even had one of the doctors approach me and tell me that he is relieved that i'm getting help because he said that he was really worried about me for awhile!
I still have a long way to go, this improvement has renewed in me hope that one day I will be well again. I'd really like to continue with the IV Rocephin treatments to see how far I can go.
Thank you all so much for your continued prayers and support. Posted by bettyg (Member # 6147) on :
great update today~!~ your co-workers & drs. noticing a great change in you!! what an upper xox
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mtree
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