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» LymeNet Flash » Questions and Discussion » Medical Questions » bluecross blue shield or MEDICAID ?

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Author Topic: bluecross blue shield or MEDICAID ?
lisalymetexas
Junior Member
Member # 49263

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Hi, I have been on Lymenet for years, but have never posted.

In a nutshell, I have been sick for over 25 years. Doc's thought it was all because of osteomyelitis in my face and sinuses. Had 13 sinus surgeries, IVIIG, etc. My sinus surgeon had me get tested for Lyme out of the blue in 2003. I was positive then and still am. I am cdc positive.

I have been on orals for at least 13 years. I have to stop most because of major stomach problems. My supposed doctor gives me a very hard time every time I can't handle them.

I have been with my husband for 17 years, but never officially married. I am in Texas which does consider us common law. I have the chance to get on his insurance through Blue Cross Blue Shield.

Do they cover IV antibiotics? I don't dare call them and send up any flags. I am currently on medicare and Medicaid. I know I will lose Medicaid if I go on his insurance. The point is, I am afraid of having less then I do now if BCBS won't cover.

I am sick every day of my life like many of you. I am completely housebound. I can't even be outside because of the light. I AM DESPERATE.
PLEASE HELP.

Thanks to everybody who responds,

Lisa

**edited title so that you may get more feedback***

[ 11-17-2016, 09:15 AM: Message edited by: Lymetoo ]

Posts: 4 | From houston texas | Registered: Nov 2016  |  IP: Logged | Report this post to a Moderator
Lymetoo
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Most insurance companies will NOT pay for IV antibiotics. They might pay for ONE MONTH and then you will have to fight for every single day, week, or month after that.

It might be better to stay on Medicaid.

Also, you will still have gut issues even from IV antibiotics. I'm sorry to be such a downer.

--------------------
--Lymetutu--
Opinions, not medical advice!

Posts: 94463 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
randibear
Honored Contributor (10K+ posts)
Member # 11290

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I went to a llmd and he ordered a ton of tests. for some reason it was marked lyme. they refused to pay and I ended up paying 1200 bucks. I fought it and lost.

they also would not pay for igenex. that cost me almost 500 through the drs office.

texas drs dont believe in . lyme and neither do the insurance companies.

thats why llmds want cash and if they request something its really scrutinized.

--------------------
do not look back when the only course is forward

Posts: 12262 | From texas | Registered: Mar 2007  |  IP: Logged | Report this post to a Moderator
sammy
Frequent Contributor (5K+ posts)
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Right now is time for yearly plan sign -ups for Medicare drug, Supplement, and Advantage plans.

My advice from personal experience is to get a a big name (like Anthem, Humana, United Health Care) Medicare Advantage plan that has at least 4 stars.

Be sure to pick a PPO, not an HMO or anything else! This will give you the most coverage and freedom to see any doctor at any facility in any state.

Then keep Medicaid as your secondary insurance. They will cover all your copays and such.

If you switch to your husbands plan, you will have to pay much more out of pocket. And you are not likely to have better coverage.

Workplace plans are made special for each group based on what the employer wants to cover. They can have many random restrictions on services and coverage that can make treatment very costly or even impossible!

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Lymetoo
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Good advice, sammy.

Can she get the Medicare Advantage Plan without signing up for her hubby's insurance?

My Medicare Advantage Plan is pretty good... it's a group plan through my teacher retirement.

--------------------
--Lymetutu--
Opinions, not medical advice!

Posts: 94463 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
SickSam
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Lymetoo, that wouldn't be TRS of TX would it?

I'll be looking possibly at getting a Medicare advantage plan when I become eligible this March and I've been wondering how good the Texas TRS plans are.

Posts: 748 | From Texas | Registered: Feb 2015  |  IP: Logged | Report this post to a Moderator
Lymetoo
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I'll PM you.

--------------------
--Lymetutu--
Opinions, not medical advice!

Posts: 94463 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
lisalymetexas
Junior Member
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Hi,

Thank you to everyone who has replied to my post. I'm sorry I haven't been on lymenet due to the flu.

I have been researching the Medicare advantage plans being offered in my area, but most are HMO's. I have also been reading the coverage for Lyme for each insurance co. and it's not good.

They list studies from 2006 and of course the CDC.
They also get their studies from Infectious disease docs.

I am so afraid of going with the wrong insurance and having to fight with them to try IV, how long I can be on IV and if it doesn't help me, not letting me be on orals.

Lisa

Posts: 4 | From houston texas | Registered: Nov 2016  |  IP: Logged | Report this post to a Moderator
TF
Frequent Contributor (5K+ posts)
Member # 14183

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It sounds like your current Medicare plan has been paying for your oral lyme antibiotics. Is that correct?

If so, then that sounds like sticking with them would definitely give you coverage for oral meds.

Just assume that most if not all insurance will only pay for 30 days of IV for lyme or the coinfections. That is a pretty safe assumption since that is what nearly all of them do.

If your current Medicare plan is paying for oral meds for lyme, they most likely will pay for IV meds for lyme also, but just for 30 days. You could always get lucky and they would agree to an additional 30 days, but that is it in nearly all cases.

So, it is the rare insurance that will pay for 6 to 9 months of IV which is what most lyme patients need.

Just take what you can get when it comes to IV. The problem is that sometimes you can't get an answer in advance from the insurance company. So, then you continue on with IV for a second month and later find out that insurance will not pay for it and you are stuck with the bill.

So, if you don't want that to happen, then stop IV when the insurance has not informed you that they will cover it.

That's my advice if money is tight.

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susank
Frequent Contributor (1K+ posts)
Member # 22150

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I live in Houston.
I have a Medicare Advantage plan.
Humana Choice PPO.
It's been much better than I had expected.
I use Coram as my specialty pharmacy.
I've not done IV Abx but other things IV.
I had talked to Coram about IV Rocephin - they said they could send it to me.**
**to add - I don't know how many months the insurance would have covered it.

At that time I had a nurse come once weekly to put in a saline lock.
Then I learned how to start IV's on myself.
I also qualified for financial hardship with Coram so I don't pay for anything.
I am single and monthly income is low.
If I understand correctly - and seems to be the case - some of the Advantage plans are not as "strict" as straight Medicare.
For me - the Humana Med.Adv. plan covers some things Medicare would not.
I would think the plan I have would be offered all parts of Houston.
If I can help more - let me know.

--------------------
Pos.Bb culture 2012
Labcorp - no bands ever
Igenex - Neg. 4 times
With overall bands:
IGM 18,28,41,66 IND: 23-25,34,39
IGG 41,58 IND: 39
Bart H IGG 40

Posts: 1613 | From Texas | Registered: Aug 2009  |  IP: Logged | Report this post to a Moderator
Lymetoo
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I would stick with the Medicare myself if you are interested in IV abx.. because NO ONE will pay for more than a few months of it.

--------------------
--Lymetutu--
Opinions, not medical advice!

Posts: 94463 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
   

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