I am currently being treated by a LLMD who wants to put me on IV rocephin. Insurance dened me coverage b/c I didn't have a positive test... Paying $5,000 to have a picc line put in is kinda ridiculous. Are there any other routes I can take here for the picc??
Thank You - Any feedback is appreciated.
-Brett
Posted by katiebobatie (Member # 28753) on :
its $5000 without insurance?!
eek, i am so scared now, as i was planning on having it done soon myself, and do not have a "positive" test either :/
i hope other people can give some other alternatives!
Posted by bfunk (Member # 32354) on :
Yes, 5K is without insurance. It's unbelievable how these insurance companies "run" your life......
Posted by katiebobatie (Member # 28753) on :
that is terrible!
are you allowed to make payments on something like that?
i just got blue cross and blue shield... im hoping they don't deny me coverage too!
Posted by bfunk (Member # 32354) on :
Unless you have a "positive" lyme test, they will not cover IV treatment.
I did a test through Igenex lab in CA to try to get a positive. The closest I got was 2 bands on my western blot that were "indeterminate." Are you seeing a lyme literate doc?
Posted by bfunk (Member # 32354) on :
Wait, you say you have a double positive and bands??? Why wouldn't insurance help? You may be ok. Don't get discouraged. I know that's difficult to hear. Where did you move to???
Posted by scorpiogirl (Member # 31907) on :
Hi Bfunk,
Are you sure about that? I don't have a CDC positive test either... so while my Insurance denies IV medication, they still covered my Hickman line placement which was more expensive than the Picc line.
I had Picc line put in last year which was covered as well. I think if they bill through major medical it will be covered. So far I got visiting nurse and dressing supplies covered as well. The only thing we're fighting w/ them over is the IV meds which are around $6-8K a month.
Also what I learned is when I called myself the insurance co always tell me it's not covered. When the hospital/or Dr's office called they get authorization... so I'm not sure why that is! So unless the surgeon's office call you and said the procedure is NOT covered then you won't know for sure! So have your Dr write and order and have the surgeon's office work on that... that's the only way to know for sure!!
Posted by sammy (Member # 13952) on :
Some home healthcare companies have nurses that are specially trained to place PICC lines. This may be an alternative solution.
You should also contact the hospital's financial aid department to see if you might qualify for a reduced rate if you need to pay out of pocket for any medical bills. They are usually willing to work with you.
Posted by katiebobatie (Member # 28753) on :
bfunk,
my test is negative, but yes, i have some positive bands. did you originally mean you just have to have a positive band for insurance to help?
i am so confused... how can anyone afford to pay $6000-$8000 for the actual meds?! that is absurd!!!
i just moved to oregon, (was originally treating in missouri) but i'm planning on going to san fransisco for treatment here.
i just hope i have some options and can afford everything some how... i'm gonna try not to worry until my actual appointment..
Posted by katiebobatie (Member # 28753) on :
also, i called a friend of mine who had lyme and beat it with iv-anti-biotics, and she says theres a new law where insurance can't deny you treatment if the doctor says it's neccessary..
still, i do not have the energy to take an insurance company to court (as im sure you guys dont either) so maybe they just say no until you *make* them pay!
Posted by Razzle (Member # 30398) on :
IM antibiotic injections are an alternative to IV, and cost considerably less. They are more painful, however...
Posted by katiebobatie (Member # 28753) on :
razzle,
are they as effective?
Posted by sammy (Member # 13952) on :
Be aware that laws may vary by state.
Here in Ohio it is perfectly legal for the insurance company to deny treatments. I used a lawyer, appealed multiple times, then took the case before the state board for review.
My Lyme tests were positive through Quest labs, I was also positive for multiple coinfections. I have severe neurological symptoms that warrant IV treatment.
They were still able to deny my IV antibiotics based on the IDSA's guidelines.
It is sad, you should be aware that it can happen. Know your insurance policy, get approvals in writing before starting IV therapy, you don't want to end up with a very large bill that you cannot afford. I learned this lesson the hard way.
Posted by momof4tnsickofticks (Member # 24577) on :
We are just beginning our journey for Lyme...my son that is 7 has a positive Igenex test, and we have a LLMD...he is now on Rifampin & Zithromax. We have been on the phone for weeks with ins. company...they are not going to cover the amount of Zithromax that we need. We will need to pay out of pocket about $5 per pill...I'm afraid this is just the beginning Posted by 4Seasons (Member # 14601) on :
I agree that you may have better luck with the provider trying to get your insurance to cover the procedure.
I didn't think my insurance would cover anything. I went to an outpatient facility where they do lots of these (Radiological procedures), so there was no additional hospital bill. The total was $2,500, the insurance paid about $450 - not much, but more than I would have been able to get out of them. The insurance clerks at these facilities are the pros at dealing with insurance.
If you are able to get a PICC line or Catheter in place, use a mail order infusion pharmacy for the best prices. PM me if you want the name of a great infusion pharmacy.
Posted by katiebobatie (Member # 28753) on :
i really think to get IV anti-biotics covered, my best bet is to find a doctor who accepts insurance..
it seems like the doctors office is much better at getting insurance to cover IV stuff..
i found a doctor who takes insurance and doesnt charge much out of pocket for the IV route, but he will not take any new patients...
all the other doctors ive found who do IV do not take insurance...
it feels so hopeless!
my last LLMD (who also didnt take insurance) said that i am running out of oral options, and that i needed to consider doing IV anti-biotics..
it seems impossible though
i dont know where to go from here!
Posted by scorpiogirl (Member # 31907) on :
FYI, my doctor's office is completely incompetent so I now I would not say they are better at getting my insurance to cover for anything. In fact for my Hickman and Picc line placements I was the one doing all the leg work!! So don't go on that assumption and give up.
In my case my Infusion company's Pharmacist was the one who is fighting my insurance and he seems to know what he's doing! Fingers crossed that they will pay for my meds!! So don't give up find a good Infusion company who know what they are doing and how to get authorization!
Posted by katiebobatie (Member # 28753) on :
i did find a doctor (who is highly reccommended here) who i've been told can help me.
the receptionist told me that it takes a while and can be a pain, but they eventually always get the insurance companies to cover IV treatment.
i talked to another lady over a support group in my state, and her daughter had that experience.
her daughter also had the same insurance as me, so i am hopeful.
her experience is very different from what i'm hearing about here, so i'm hoping mine is more like hers.
it is worth a try. he's supposed to be a really good doctor none-the-less.
Posted by katiebobatie (Member # 28753) on :
thanks for all the info optimistick!!!
hope i don't have to appeal, but if so, i will definitely use that information!!!
![[Frown]](frown.gif)