Topic: Anyone have insurance cover IV rocephin long term?
blinkie
Frequent Contributor (1K+ posts)
Member # 14470
posted
My LLMD wants me on IV rocephin next. I called my insurance company and they said it was covered. I asked if there was a limit on treatment duration and they said "no information is listed that limits the length of treatment".
So, can I trust this info? Has anyone else had this covered long term by insurance? Should I expect that they will cut me off after 28 days or as soon as they catch on that I've been treated too long?
My ins is blue Cross and they have covered everything else so far with no questions asked, including 10 months of mepron, minocycline, omnicef, zithromax, and several other things.
Posts: 1104 | From N.California | Registered: Jan 2008
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seekhelp
Frequent Contributor (5K+ posts)
Member # 15067
posted
Probably 28 days max. It varies in each state, but 99.99% of insurers follow the IDSA guidelines. By the way, just because they say it's 'covered', READ the fine print. It may be covered only with a positive ELISA and follow-up WB IgM and IgG with CDC positive criteria. These insurers can be tricky.
Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008
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feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
I have Blue Cross Blue Sheild Federal Employee Ins. and my IV was totally covered for the 4 months that I was on IV.
I was never questioned or threatened with cut-off....my perception is that they would have covered much longer...it was my doctor who cut me off.
Good Luck
Posts: 3975 | From usa | Registered: Aug 2007
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tdtid
Frequent Contributor (1K+ posts)
Member # 10276
posted
It's really a hard call since some are sliding through and others aren't. I too have have BCBS and have been on IV for 7 months, but since ours is privately owned, they don't need to stick with state law and are going off of IDSA guidelines.
We are still appealing, but still no luck, but I know others are getting it through, so I guess you try and hopefully it will slide through.
We were told they would only cover 28 days, but we are still waiting for a refund even on that after 7 months. We do what we have to do for survival, but it's tough when you don't feel well and don't have the strength to fight.
Good luck to you and hopefully your insurance will have a heart.
Cathy
-------------------- "To Dream The Impossible Dream" Man of La Mancha Posts: 2638 | From New Hampshire | Registered: Oct 2006
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posted
I live in Minnesota and my son had IV meds for about 1 year. The treatment was covered 100%.
MN Statue:
62A.265 COVERAGE FOR LYME DISEASE. Subdivision 1.Required coverage.
Every health plan, including a plan providing the coverage specified in section 62A.011, subdivision 3, clause (10), must cover treatment for diagnosed Lyme disease.
-------------------- Peggy
~ ~ Hope is a powerful medicine. ~ ~ Posts: 2775 | From MN | Registered: Apr 2001
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posted
We also have BC/BS and my husband is currently on IV Rocephin and another ABX. We are covered about 100%, no limitations. He's been on treatment since mid-January, and the insurance company told me we are covered until the "patient feels they are better" or until we decide to stop treatment.
This was a bit of a worry for my Husband before he started treatment, but we are fortunate to have top notch insurance that is covering all of his meds, MRI's and any future treatment he needs. BC/BS is very good insurance.
Rocephin is very expensive, so all of us with insurance that are being treated with these costly ABX should be thankful we have it.
Posts: 64 | From rock tavern ,new york | Registered: Aug 2008
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posted
Anyone have experience with United Healthcare covering IV Rocephin or other abx ? The LLMD dx Lyme (w/out labs -- still waiting on those) and said he will likely want to do IV. I think we can only get 1 month covered and that requires "objective findings" of Lyme. He wants to do longer since I have more advanced neuro, cognitive, cardio, etc symptoms.
We are really torn on whether to stay with the LLMD (requires you follow his treatment) and doesn't take insurance or whether to try it with my PCP and use the insurance, hoping for the best. This tx with the LLMD will ruin us financially.
Any thoughts ?
Posts: 41 | From SC | Registered: Jan 2009
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posted
Don't trust this info. There are so many loopholes they can use to deny coverage (as someone else mentioned, must have positive elisa, or in my case that treatment is not medically necessary). Also, they can agree to cover it but then refuse at time of payment if they deem it not medically necessary or a number of other reasons. Plans under different employers will allow for different things.
You need to get it in writing if possible that they will cover the expenses (and who knows how long before they cut it off?). I wouldn't trust the person on the phone telling you that they will. Dig into the text of your insurance plan.
Posts: 236 | From Washington | Registered: Jul 2008
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