Interested in any stories people have on getting Bicillin covered by insurance. Has it generally been covered or not? My insurance will cover it if I do it at the doctor's office each time but that does not work well with my work schedule. They will not cover it if I do the injections myself. Any experiences would be welcomed.
Posted by David95928 (Member # 3521) on :
There's away I can file through "Major Medical" for 80% reimbursement. They will not cover it under the pharmacy plan.
Posted by Areneli (Member # 6740) on :
My insurance also rejected me. Any good idea on the matter would be welcome.
Posted by micul (Member # 6314) on :
Mine covers it without any problem just like any regular Rx. I don't see how they can decline it? What would be the difference between Bicillin and Mepron or Zithro as long as your Dr wrote a script for it?
The only thing my Insurance won't cover is for something like Human Growth Hormone.
Posted by SForsgren (Member # 7686) on :
They say they won't cover intramuscular injections which is silly since they cover my subcutaneous Heparin. I think if I get it done at the dr. each time, they will pay for some of it, but that doesn't work with my work expectations. So I am pushing to get them to cover it so I can do it myself....
Posted by Lymeindunkirk (Member # 7118) on :
I have Anthem Blue Cross Blue Shield and it is covered. I'm sorry to hear that your having difficulty. It seems to be doing wonders for me. My phobia/fear of bridges and heights has suddenly disappeared all together after being on the bicillin for two months. I can hardly believe it. I am feeling much better as well. Unfortunately what works for one doesn't always work for another. I have only positive things to report with this drug.
Posted by Jill E. (Member # 9121) on :
Scott,
I'm on an individual Blue Cross PPO and was denied - I had to pay completely out of pocket full cash price. Yet I know another Lyme patient in my city with a Blue Cross PPO - but a group plan and they cover it.
I filed a grievance against Blue Cross, including all kinds of back-up about my being a neuro Lymie, Bicillin having almost equivalent results as IV and that we were trying this to postpone or avoid IV, we all the medical reasons it was being used on me -and that they obviously had different standards of care if they wouldn't cover me but covered a fellow Lyme patient who lives 10 minutes from me with even less severe symptoms than mine.
My grievance was denied. I have to go the State board but am too busy right now with other family problems. And they sent me a copy of their Lyme guidelines saying intramuscular injections are experimental for Lyme. But again, they cover other Lyme patients for it.
But FYI, the clinic where I go to use the nurse to give me the injection (I would bring the Bicillin, she would just give the injection) was able to order a box, bill Blue Cross for the Bicillin and the nurse's fee, and they are now paying a part - I still have a pretty hefty co-pay per shot - but so much less than what I was paying just for the Bicillin before.
Unfortunately, this was probably a onetime thing that they could even get the Bicillin for me. They hadn't been able to before. I had to always go through the beg, plead, send paperwork and coordinate between King Pharmaceuticals, a retail pharmacy and a distributor to even get the stuff.
What kind of insurance do you have?
Jill
Posted by SForsgren (Member # 7686) on :
Thanks all for the information!
Posted by fatigued15 (Member # 6437) on :
HI Scott,
My son's Human Resource called his insurance and got this covered for him. It might be worth a try.
My son had a constant herx from the Bicillin. He had to stop the injections. Hope things work out for you.
Posted by WildCondor (Member # 434) on :
Hi Scott... You can get a prior authorization form for the Bicillin from your doctor, have the MD write "self-injection OK" on the form so that the insurance company will approve you doing the injections at home yourself. You will need the Tubex injector along with it.
Thats what did the trick for me. They gave me the BS about it having to be done at a Dr. Office too... once they wrote that note, I got it approved and did them myself. Hope you are doing well Posted by SForsgren (Member # 7686) on :
Perfect. Having the doctor try that tomorrow. Thanks Wildcondor. Posted by timaca (Member # 6911) on :
If wildcondor's suggestion doesn't work, then consider contacting your state insurance commission. That seems to be what has helped me the most.
Timaca
Posted by NoVAChick (Member # 9814) on :
I had a good experience contacting my state's Ombudsman for Managed Care regarding insurance coverage (but for Rocephin, not bicillin). I was told that if the employer has a fully-insured plan and the policy is written within my state, the insurance commission can help with coverage issues at no cost.
If the plan is self-insured (like my employer), there is someone within Benefits (I think a Benefits Broker?) who can override the insurance company's denial. The reason for this is that in a self-insured situation, the employer pays the claims and hires a 3rd party plan administrator. The employer, in this situation, actually has the final say. Unfortunately, this didn't work for me. And, ironically, I work for a pharma company!!! So now I am working with a lawyer to appeal.
Posted by NoVAChick (Member # 9814) on :
I just received a prescription for my bicillin LA shots and asked my pharmacy (in the grocery store) if they carry them. I was told they did not. My PCP is going to give the shots to me, but my LLMD in NJ wrote the prescription. Where do I go to get the shots to give to my PCP to give to me? Thanks!
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