In my state (PA) I think it has been only 60 days anyway. Still not long enough to do any of us any good.
Plus, I've heard that if you do IV, you then end up on their radar and are less likely to get approved for the orals that you need.
I've chosen to stay away from IV and am progressing pretty well albeit slowly with orals alone.
Corgilla
-------------------- "I'll never forget good old Whatsisname." Posts: 694 | From PA | Registered: Jun 2003
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char
Frequent Contributor (1K+ posts)
Member # 8315
posted
We are in NC. My husband wks in VA. Hadn't considered that NC insurance may be better.
News is they will cover. 28days only. Period. This is causing a lot of havoc for folks seeing our dr.J in NC. They have been great informing us and trying to help.
Daughter just completed 8wks of IV, which BC/BS y did cover.
She had complications with her line, and took 1 month break. Really need to restart ASAP.
She cannot tolerate orals and we have much documentation on this and will try to use this in our fight.
The word at this pt is that they will cover insertion of piccline which makes no sense, but we will of course be much relieved if they do.
I will start shopping for the abx today. Last yr found rocephin 2grams for $70 a pop.
She is infusing 2 different abx, 3 doses altoghter, so that will be a challenge.
Last yr our former insurance policy was 6wks and we got 8wks out of them for daughter and 10wks for son.
Thankfully, my husband is not sick and I have hope of getting better to pt of working some next yr. Praying and trying to stay calm.
Worried about others being affected by these changes.
if you can believe that. So, theoretically, if you get 30 days of Lyme treatment, and then get re-infected or end up with some form of sepsis or other infection.. I guess you're out of luck.
Posts: 8337 | From the other shore | Registered: Jul 2002
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trails
Frequent Contributor (1K+ posts)
Member # 1620
posted
This is their "policy" in CA. Exactly.
Makes no sense.
However---FIGHT IT!
Will be posting in a few days about my insurance battles (that I am about to WIN)!! But waiting on final approval---the check in the MAIL!!
>> get the Lyme Times Insurance Issue and memorize it.
You must talk tough. You know what you are talking about. You must threaten legal action. You must keep a record of EVERYTHING! These things WORK.
Also there is ALWAYS a loop hole if you look hard enough. You'll find one for your daughter.
I will be donating a portion of my insurance "payback" to CALDA and the Lyme Times. If it werent for their hard work, I wouldnt have understood this complicated bussiness of insurance and gotten this far!
Posts: 1950 | From New Mexico | Registered: Sep 2001
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Michelle M
Frequent Contributor (1K+ posts)
Member # 7200
posted
I am in California and on Blue Cross.
Their policy is "30 days max." No matter what.
I would have fought, but liver problems prevented my continuing.
Our own TIMACA (Yeah!!!) fought them and won!! She used the Lyme Times protocol also. Took a while but worth it.
Blue Cross really sucks.
Michelle
Posts: 3193 | From Northern California | Registered: Apr 2005
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
I am in NC and also have BCBS and have heard this. Fortunately, I am long past IV, but have heard this from other patients who are in the middle of IV treatment.
BCBS covered everything for months when I was on IV, no prob. Think the recent charges against Dr. J certainly do not help our case for longer IV. And until this situation resolves, it is doubtful they will change their mind.
They have been very hard-nosed on some nutritional medicine treatment I had and I have been fighting them for more than a year. They are tightening up on their policies on Lyme treatment in general.
Fight them. Get a health care advocate to help. The longer you stay in the appeal process, the more chance you have to overturn them. Throw info at them. Get good quality journal articles. Anything to make your case.
Good luck....
Posts: 2275 | From NC | Registered: Oct 2000
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char
Frequent Contributor (1K+ posts)
Member # 8315
posted
Thanks for the encouragement, everybody.
Congratulations, Trails on your victory. Good news goes a long way.
posted
The BC/BS federal plan covered 6wks, no questions asked. That was last year though... They've treated me pretty well (actually extremely well). I had a couple thousand dollars worth of MRIs and labs done in Singapore with no referrals (just for my own reference), and they paid %100. Hopefully, I'll continue on my lucky streak when I start seeing the LLMD.
I know state to state they have some varying rules about IV therapy.. Like when I jumped from home health care in Virginia to home health care in Washington State (which absolutely sucked. I have not one friendly word to say about the nurses in WA), I had to start using a pump, instead of pushing the Rocephin through. in VA, they could care less.
All I can say after reading all the posts about everyone's insurance woes is thank the lord for workman's comp.
-------------------- Sometimes when I say �Oh, I�m fine� I want someone to look me in the eyes & say �tell the truth�
posted
Trails, how about copying this info to MINOUCAT'S INSURANCE & DISABILITY link found in treepatrol's newbie links? This is very informative; thanks for posting it!
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char
Frequent Contributor (1K+ posts)
Member # 8315
posted
Hi,
I am searching Lyme Times archives and can't find the insurance issue.
posted
My LLMD's office said that when the information came out that they'd be cutting back the coverage for infusion therapy, they specifically asked for Lymie's records. If they are going to do that to Lymie's they better freaking make ALL infusion therapy patients stop or pay for their own treatment after 30 days.
-------------------- Sometimes when I say �Oh, I�m fine� I want someone to look me in the eyes & say �tell the truth�
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