posted
My insurance won't cover. Help!?
Posts: 641 | From Nevada | Registered: May 2009
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
I have known cases where the lyme doc got involved and got the insurance to pay for it.
Posts: 9931 | From Maryland | Registered: Dec 2007
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posted
My insurance paid for most of it but I still had to pay several hundred dollars. Would it be effective if you were given a prescription for half of it?
Posts: 653 | From Northern Virginia | Registered: Oct 2014
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But I mean how can they deny a prescription a doctor gave me, the insurance company isn't my doctor, how can they deem what is medically necessary? I don't get it.
Posts: 641 | From Nevada | Registered: May 2009
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me
Frequent Contributor (1K+ posts)
Member # 45475
posted
First off, I'm terribly sorry you are in this situation.
Did they completely deny it or did they require preauthorization? Each insurance plan is different, and they have certain things they will and will not cover. I would check into both of those things.
Then, you get into the fact that insurance companies are business that want to make money and don't like shelling out money. You add the layer of restrictive IDSA guidelines, and this is what happens. That's a whole different story.
Worst case, can your doctor prescribe a like drug that will be covered? Also, does your insurance company have an appeals process?
Someone I know on here got denied a prescription but then appealed it and got I covered.
Best.
-------------------- Just sharing my experiences, opinions, and what I've read and learned. Not medical advice. Posts: 1431 | From USA | Registered: Mar 2015
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Double check what the reason given for coverage is. Anything that my doctor marked as needed for "Lyme Disease" that required prior approval got denied.
If it was marked for any other infection ... "babesia" "bartonella" .... it got approved.
Just double check that he asked for a babesia med and not a Lyme med.
-------------------- sixgoofykids.blogspot.com Posts: 13449 | From Ohio | Registered: Feb 2007
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me
Frequent Contributor (1K+ posts)
Member # 45475
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Very good advice, SixGoofyKids!
-------------------- Just sharing my experiences, opinions, and what I've read and learned. Not medical advice. Posts: 1431 | From USA | Registered: Mar 2015
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
If insurance continues to deny Mepron, your doctor might consider Malarone.
Check to see if that or the generic ( Atovaquone/Proguanil ) is on your formulary.
Posts: 5237 | From here | Registered: Nov 2007
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Don't let them off easily or they will continue doing this to you and others. FIGHT for it! Please!
Here are some discount coupons, reduced med sites, patient assistance programs for Mepron, etc.
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