Does anyone know if Medicare A, B, and/or D will cover IV ABX?
I've been calling Medicare for 4 days now, and still no answer, can't even find the right person to ask.
Here's the story: My Dr. is 1 1/2 hr. drive from home. I cannot drive.
If my current protocol is not effective (oral ABX, lots of other goodies), then in 3 months she would try the IV ABX. It would be Rocephin, 2 grams, 4 times per week, for 3-4 months.
Someone suggested that Medicare has Home Health Care, which may send cover someone coming to my home to administer the IV. Does anyone know how to find out if I'm eligible? Has anyone here done this?
Then there's the drug coverage, that would be through the Part D. I tried to plunk that in on the Medicare website where you select your Part D drug coverage, with the 2 Gr., but it would not accept the amount. I currently have private secondary insurance, but soon that will end and I have to select a Plan D.
Thanks friends. Hopeful4
Posted by AZURE WISH (Member # 804) on :
I am not postive but I have been told medicare will pay for iv for about a month (I think the exact number is 28 days)for lyme.
I believe If you are homebound medicare covers home health. If you are not homebound then you have to go to the hospital every dose to infuse.
But this info was before part D existed ... I dont know if that changes things.
Best wishes
Posted by hopeful4 (Member # 8486) on :
Thank you Azure Wish(what a beautiful name). I had a pretty frustrating day on the phone w/Medicare, over other issues as well.
After a jillion calls about the IV, I finally was directed to a local Home Health provider of Medicare services. We left each other voice mails, but at least I now have a direct number to call next week.
Any other folks have experience with this?
Thanks.
Posted by deb obrien (Member # 5239) on :
hi hopeful - i went through all these hoops a month or so ago - have now been on rocephin for almost 3 weeks....and i'm feeling bettter...
medicare will not pay for home infusion for antibotics - homebound or not....i find this very ironic as i was once a visiting nurse. anyway, i got considerably better after increasing my flagyl dose accidentally (was really sick for awhile, though) but at the end was much better and able to leave the house for short periods most days....
i got my primary md on board - it took a while to get her and my llmd to communicate but finally she ordered a picc and 2gm rocephin daily. i am not allowed to go to the infusion center as i have an infection!!!! (although the head nuse told me that they occsionally have aids and hep patients there!!) anyway, i call the outpatient surgery department and tell them to order the rocephin and go down to the op surgery dept - they have made it very easy....
on days when i don't go to op surg (weekends, holidays or days i feel too crummy to leave home)i do my infusions at home...you can order all the supplies you need from infuserve america 800 886 9222 (your llmd's staff should be able to do this for you) - MEDICARE WILL NOT PAY FOR THESE!
i have united health care - aarp - plan for part D...the first time i picked up 10 vials of recphin it was $28. the second time it was around $850.00 - i am now in the donut hole!!
i have elected not to have the extension tubing added to the picc line - instead i went to the local hardware store and bought a niftly sort of long handled pliers that can hold the ends while i screw in the iv tubing, syringes, etc.
from infuserve america, i bought a nifty little shower sleeve for about $10.
i could have had the picc inserted lots sooner if i had gone to the llmd's hospital...but then i would have been totally on my own...it's nice having the local outpatient surgery handy even if i end up only using them occasionally for dressing changes....
beware however if you have nurses that aren't used to working with picc lines - they haven't all been inserviced!!! i had one that tried to stick a needle in and have a couple who didn't understand that they couldn't irrigate with anything less than a 10 cc syringe...it sounds counter intuitive but the smaller the syringe is the more pressure is exerted when you inject something (just think of a large hose and when you put your finger over part of the water the pressure goes up)...anyway, by using smaller syringes , there is too much pressure and you can wreck the thing.
for some odd reason, my primary ordered a double lumen - she didn't know any better and by that time i was just so happy to be getting it in that i didn't question it...my choice would be a single lumen (only one dangling nozzle instead of two).
my llmd ordered actigal - can prevent gall stones and i'm due for an abdominal ultrasound in a week or so....i have had very little gut pain in the two and a half years that i've been on antibiotics but have been getting some lately...so it was decided to get an ultra sound as a baseline....
one of the unexpected perks about this is how interested my primary md has become in this treatment..i hadn't seen her for several years as had been seeing more alternative types....
good luck, deb
Posted by hopeful4 (Member # 8486) on :
Thanks for your response. What a major ordeal.
So, the bottom line is that Medicare will not pay for any IV ABX, whether at home, at the Dr. office, or as an outpatient...is that correct?
But you said your Part D paid for the Rocephin, at least partially? Then you go to out-patient surgery? Who pays for that?
I'm pretty well confused. Thanks.
Posted by cawpo (Member # 5744) on :
I had a picc line and last did rocephin 10/05. At that time Medicare paid as outpatient for the picc to be inserted at the hospital. And paid for the IV infusion as an outpatient. I did that until my picc healed.
But the hospital is 1/2 hour away and I was too sick to go.
At that time I had no rx insurance and was able to get the drug from Roche. Medicare would pay for home health to come and show me how to do the infusion myself. And once a week to change the picc dressing. They paid for the dressings, tubings, and alchol. I think needles and syringes. And would do blood draws.
I had to pay for the flushes.
I was home bound unable to drive.
If you do rocephin be sure to take the actigal to protect your gallbladder.
I know it is all over whelming to get someting like this sorted out and lined up.
Posted by hopeful4 (Member # 8486) on :
cawpo, Thank you for your info. It helps a lot to know this. Now I know that I can specifically ask for something like the scenario that worked out for you.
As you must know, when calling Medicare it can be so frustrating. Also, I searched on some past posts re this topic, and it seems that people had many different responses from Medicare, it wasn't consistent.
OK, I'm armed with some knowledge for my next round of calls. Thanks.
Actigal- I don't have a gallbladder, it was removed a while back, before I knew I had Lyme. Will that make a difference?
How did you feel during the Rocephin treatment? And how are you feeling now? Sure is a lot to go through, hope it helped you!
Posted by deb obrien (Member # 5239) on :
sorry hopeful - i was not very clear - medicare pays for everything that i have done in the hospital - nothing that i do at home....so if i go to outpatient surgery they pay for rocephin, iv supplies, dressing changes, etc....this is the only reason i go!! and the hospital is only a couple of miles away...
when i do the infusions at home, i pay for everything...rocephin is included in part d medicare (i get it from walgreens), but the iv supplies aren't...if i got the rocephin as well as the iv supplies from infuserve america, the rocephin is not included in part d.....the infusion companies do not bill to medicare or use medicare part d
good luck, deb
Posted by cawpo (Member # 5744) on :
I did IV Roe twice the first time for 9 months. The first few months VERY, VERY bad herxs. I actualy got worse. Then as I was finally turning the corner I had to change insurance companies and they would no longer pay for it. So I did just orals.
6 months later I was put back on IV roe this time I Had my disabilty and on Medicare. My dose was higher. I did not get so sick but not it was't a miracle drug. But after 7 months I was having troulbe with my picc line. So it had to be pulled.
I think if I could of had it a little longer the first time it might of really helped me.
I was on orals also at the same time.
Now I am on injectable Bicillin LA. That might be something to try before the IV. Easier than dealing with a picc line. No you woud not need actigall.
Just remember every person is different.
Best of luck to you. Cheryl
Posted by cawpo (Member # 5744) on :
Hay, I forgot one important thing!! Think positive!! You have to give your protocal the 3 months to work!!!
Hopefully you won't need the IV!!!!
Cheryl
Posted by hopeful4 (Member # 8486) on :
Thanks again.
Deb o'brien: It sounds like you got it covered if you went as outpatient, but not at home. That then depends on whether you are considered ``homebound''??
How do you ask for it to be done at a hospital? Does your doctor send the request? What if your doctor is ``opted out'' of Medicare?
OK, then, at home, the Part D will cover the Rocephin, but the Medicare won't cover the supplies and technician? What Part D coverage do you have?
I'm trying hard to understand and clarify so that when I call Medicare I know what questions to ask.
Cawpo: No easy answers for any of us, and, when insurance dictates what we can receive or not, it's more complicated.
I'm not sure about the bicillin. I've had some reaction to penicillin in the past, not anaphylactic, just jitters, and rapid heartbeat (that was enough), so I'm probably not a candidate for the bicillin.
Staying positive: Working on that one daily!! Feeling worn down and weary. I do say many gratitude prayers throughout the day. I agree, it's so important to stay positive. Thanks for the gentle reminder!
Posted by deb obrien (Member # 5239) on :
hi hopeful, medicare pays for everything at my local hospital where i had the picc put in and where i get rocephin infusions....this had to be ordered by my local primary doc, not my llmd who does not have privileges at my local hospital..she (my primary doc) faxed a prescription to the hospital and gave me a copy of it....it took 6 weeks after seeing my llmd who thought rocephin indicated to get my primary doc to agree with it.
from what i understand, it makes no difference whether or not you are homebound - medicare will not pay for antibiotic home infusion services - i called several infusion companies...i was actually homebound when my llmd first ordered rocephin...the people at infuserve america are very nice - call and talk with them 800 886 9222.
on weekends, holidays and days when i'm not up to going to the hospital (it's only 10 minutes away) i do my own infusions...i bought the supplies from infuserve america and i get the rocephin from walgreen's. walgreen's is the sponsor of united healthcare part d medicare ( the aarp plan)....i'm now in the donut hole so the copay is very high...if you use an infusion company, nothing is covered by part d (their pharmacy is their big moneymaker)
for me it was worth it to get my local primary doc to agree to do this - she is now very interested - she does take medicare!
to back up a minute - even if the doc who orders rocphin and picc placement does not take medicare, medicare will still pay for it....however, all has to be done at a hospital where the ordering doc has privileges...
good luck - stay hopeful... deb
Posted by AZURE WISH (Member # 804) on :
I was just curious did your llmd say it was ok to do rocephin without a gullbladder?
I lost mine to rocephin. I am probaly wrong but I thought that it was unfavorable to do rocephin without a gullblader especailly if other options existed.
But like I said I am probaly wrong - thats why I was curious if your llmd suggested the rocephin.
Good luck with your medicare calls.
Posted by hopeful4 (Member # 8486) on :
Hi deb,
you said: ----medicare pays for everything at my local hospital where i had the picc put in and where i get rocephin infusions....this had to be ordered by my local primary doc, not my llmd who does not have privileges at my local hospital.----
Now things are becoming a little clearer to me. I also searched on the web for medicare info re infusions, which seems to back up your statement.
Thank you very much for this info, it's very helpful. I don't have a local MD, but now I will look for someone who could do this for me, if I should need this.
AZURE WISH
you said: ----I was just curious did your llmd say it was ok to do rocephin without a gullbladder?----
Well, we didn't specifically discuss this one! Good point! The day I learned that if/when I do ABX that rocephin is the choice, I was discussing it with a nurse in the office. I told her I didn't have a G.B., and she said "great", even better.
But, since you bring it up, I will definately discuss it with my Dr. before going forward.
Thanks everyone, for helping me keep my head on, and facing forward!