I have been treating Babesia and Lyme for approximately a year and a half now.
I have congenital, life threatening allergies to corn, soy and dairy. (Plus multiple other sensitivities caused my by illness.)
Many derivatives of corn, soy and dairy are found in many traditional medications. For that reason I have to have all my prescription meds compounded. (Zithromycin, Clyndamycin, Cholestyramine, Minocycline).
We have been lucky so far and many of my medications have either been covered or partially covered by insurance. We are extremely grateful for that.
My husband recently changed companies and our new insurance came effective November 1st. Over the weekend I refilled a prescription for Valproic Acid (Depakote), which I intake now for seizures.
We found out that our new insurance plan does not cover any compounded medications and we will have to pay everything out of pocket.
My husband contacted his HR department to ask if they could keep this in mind when renegotiating the insurance plan next year. The pharmacy also suggested that I submit a claim form to insurance.
Has anyone else had this experience? Does anyone have any suggestions other that what we have already done - contacting HR & submitting an insurance claim?
One request: please refrain from using Graemlins in your response - they can and often do induce seizures in me.
Thank you kindly.
Posted by Rumigirl (Member # 15091) on :
If you don't get anywhere with your new health insurance (which I hope you do!), know that you can appeal and do external appeals.
And your doctor can submit information about why you need the compounded meds. That probably hold more weight with them than just your own words.
In addition to all that, you can complain to your state Attorney General's office in the health bureau. That often gets the best response of all, as they are putting more pressure on the insurance company.
I do hope that you husband's HR dept takes this under serious advisement for next year. Maybe you could let them know how serious it is for you. I know we don't usually want to give work too much health info, but . . .
Posted by Judie (Member # 38323) on :
I agree with getting the doctor involved. Maybe there's an advocate in your allergist's office that can contact the insurance company or at least write you a letter.
I was having trouble getting a prescription covered and the pharmacist contacted my doctor's office and the insurance company to get it covered.
There may be a way around this.
On a completely unrelated matter, I contacted my congresswoman's office and one of their advocates put the pressure on a company for me that was causing me ridiculous problems. The threat of getting the government involved sometimes makes a company bend.
Good luck!
Posted by Triple B (Member # 38746) on :
Rumigirl and Judie,
Thanks for the advice. We have an appointment with my LLMD tomorrow and will ask for her support.
I hadn't thought about contacting the AG but will keep that in mind if the appeals don't work.
I did meet with my State Rep this morning on an unrelated issue and he made some similar suggestions..
Thanks!
Posted by SouthPaw (Member # 35229) on :
I was in a similar situation. Rocephin was covered indefinitely by my insurance company but we had to change insurance companies last January. The new insurer wouldn't cover it.
My LLMD negotiated with WalMart Specialty Pharmacy and got my Rocephin down to $266/month from over $1200/month.
I think asking your LLMD for help is a good place to start.
Posted by SouthPaw (Member # 35229) on :
To clarify my previous post......my insurance covered Rocephin indefinitely because I also have Babs/Bart. If I only had Lyme they would only have covered 28 days. Just goes to show how damaging the politics of Lyme can be.
Posted by Anthropologista (Member # 35483) on :
So sorry, Triple B. I would try to get more than one doctor to write a letter to your husband's insurance company to make the strongest case possible.
I hope the appeal succeeds. If not, the State Rep and AG are great suggestions.
You might also let the insurance co know that you will have no choice but to bring a lawsuit against them. Judges and courts may not understand Lyme, but they do understand seizures and life-threatening allergies.