posted
My son is going to be starting IV meds at the end of this month.
We have pretty good insurance, but it *is* an insurance company.
Would it be better for me to call 'em up and ask in advance what is covered and what isn't? And for how long? Or go to war when they start trying to deny claims?
Sheesh. This bites.
Susie
Posts: 234 | From albany, ny | Registered: Mar 2011
| IP: Logged |
posted
You could try. Insurance co's generally wont say if something will be covered prior to the submission of the claim. Otherwise they would be held to it, and it all depends on the dx code and medical necessity.
-------------------- Psalm 119:50 My comfort in my suffering is this: Your promise preserves my life. Posts: 292 | From Heaven | Registered: Jan 2011
| IP: Logged |
just don
Frequent Contributor (1K+ posts)
Member # 1129
posted
Most IV meds I ever had was PRE approved. Seems like when insurance coverage runs out they quit meds IMMEDIATELY!!!!
They did for me anyway. I spose infusion company and home health care dont want to hassle the collections of a private pay.
They never even ASK me either,,just knew I couldnt afford what insurance wasnt paying.
If you drive a BMW or Porshe YOUR mileage may vary!!
But generally they DO want preapproval before hand!!
-------------------- just don Posts: 4548 | From Middle of midwest | Registered: May 2001
| IP: Logged |
posted
Personally, I think it would be better to at least do a trial treatment of oral meds for coinfections first. I do know that with hubby his first med was IV Rocephin. This was over 7 years ago. Back then insurance would pay for 60 days. It took us 90 days to do a normal 60 day dose because he was so sensitive. And back then the med was not generic so our 40% copay was thousands of dollars.
He improved maybe 25% on the med. Within a week of stopping the med his symptoms started coming back. Also at the time cyst busters were not commonly used. But he had had no treatment for either bartonella or babesia or ehrlichia before the rocephin. In my opinion the reality is that we really wasted a lot of money that I would love to have back now.
Hubby did so much better on IV's recently because his coinfections have now been treated aggressively.
I thought the specialists you consulted advised going low and slow?
Since your son is no longer a child the reality is that insurance most likely will only cover 28 days or at the most 60 days of IV. If resources are limited then it makes sense to hold off on IV until the coinfections are addressed.
I am pretty sure that the Dr B guidelines still suggest treating coinfections first?
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
| IP: Logged |
aklnwlf
Frequent Contributor (5K+ posts)
Member # 5960
posted
I personally didn't call my insurance company. They paid for the entire 16 weeks of IV's that I underwent for treatment.
Also inserting the picc-line and home health was all covered.
I just went for it and my LLMD's office staff was very helpful and said that they would assist me if there were any problems.
Good luck!
-------------------- Do not take this as medical advice. This comment is based on opinion and personal experience only.
Alaska Lone Wolf Posts: 6147 | From Columbus, GA | Registered: Jul 2004
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
If you call, ask that they send you a copy of the medical policy for IV therapy for Lyme disease. They will have a written policy that they will follow. They rarely make exceptions.
Your doctor's office should submit for pre-approval before you start the IV antibiotics. Insist that they give you the pre-approval in writing. If you do not get it in writing they can tell you anything then turn around and deny paying the claim. This happened to me. It was a very expensive lesson to learn.
I spent approx a year and a half trying to appeal for coverage of the denied claims. It was reviewed 5 times before the denial was finalized. I had the full support of my LLMD, sent in tons of medical records and letters of necessity, a giant stack of research supporting treatment, and had the help of a lawyer. They still refused to pay.
The cost of paying out of pocket for IV ceftriaxone through the home healthcare company was over $2,850 per WEEK, and I did not have any nurse visits, they shipped the medication and supplies directly to my house. If you pay out of pocket through Infuserve for the same medication and supplies the cost is $600-$800 per MONTH. There is a huge difference!
I wish someone had told me what I just told you before I started IV therapy. Now you can make a more informed decision.
Posts: 5237 | From here | Registered: Nov 2007
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[hi]](graemlins/hi.gif)
Printer-friendly view of this topic