posted
I have never filed an appeal, but I have re-filed and received a different answer. Never for IV though. They might look at that a little more closely.
Posts: 984 | From US | Registered: Dec 2007
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posted
First... I have UHC and have been on IV for 5 wks. 4 wks were covered for sure and I thought that it would end after that. However my infusion company has indicated that UHC will continue to pay for the IV meds as long as I actually go to the infusion facility to have my IV changed, and don't have them come out to my house each week. Now, I'm not sure if this is correct so I would have your infusion company check on this and have it authorized.
Second, if this doesn't work, this link might help. Has a good letter that you might be able to use:
So VB, you go to your infusion company for dressing changes instead of have a home nurse come to the house? My infusion company is in a different state.
Thank you for the link to the sample letter. UH did send a long letter explaining why they've denied extended coverage. Basically, it states that long-term antibiotics have not been proven effective or safe in medical literature.
My question to them really is if they say they will cover 30 days, then it should be by day (like what you received) and not by month. It doesn't seem reasonable that they only covered 9 days of antibiotics for me while someone else being treated for lyme was covered for 30 days.
I would be happy with them covering just 27 days of my antibiotics. I only have to be on IV for 6 months, so if they cover 3 of my months (27 days), well, it would be much better than nothing. I am happy they have been covering all of my oral meds. Hope that doesn't change.
I'll give them a call tomorrow. Maybe a simple phone call will reverse their decision...wishful thinking! Posts: 618 | From NC | Registered: Oct 2009
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posted
Yes, you are right... that doesn't seem right.
Could you find an infusion co that is in your state? I know it is a pain to change.
Maybe calling will help. I do know that I have called them before about out of network claims that I have submitted... certain procedures they denied, and when I called and questioned them about it they admitted that a mistake was made and paid.
I know it's an entirely different situation, but still maybe calling will actually help.
Do you by chance have a separate prescription plan from your health plan (ex. I have UHC for health and Caremark for prescrips)? If yes, you may be able to get the meds covered by the prescrip plan, although the home health would be out of pocket
Posts: 453 | From TX | Registered: Aug 2008
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posted
Yes, I can find an infusion company here. That shouldn't be a problem, although I do love my home health nurse...I would miss her!
I don't have a separate prescription plan. I will give a call tomorrow and then start drafting a letter. Just what I want to be doing in the midst of treatment and herxing!
Thanks so much for the info. and input!
Posts: 618 | From NC | Registered: Oct 2009
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I will let you know if anything changes from what my infusion co has told me. I recently had to switch as well, so I'm not quite sure they know what they're talking about. Make sure you check before going to the trouble of switching. I don't want to lead you in the wrong direction.
Posts: 453 | From TX | Registered: Aug 2008
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IckyTicky
Frequent Contributor (1K+ posts)
Member # 21466
posted
I found that if I appealed a few times they sometimes relented.
But I recently got a letter in the mail from them, wanting my support in them suing IgeneX for some reason. It was a long letter that my brain could not comprehend.
So if it's Lyme related... they may be buggers about it.
-------------------- IGM: 18+, 23+, 30+, 31+++, 34+, 39IND, 41++, 58+++, 66+, 83-93IND IGG: 31+, 39IND, 41+ Also positive for Mycoplasma Pneumoniae and RMSF. Whole family of 5 dx with Lyme. Posts: 1014 | From Texas | Registered: Jul 2009
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IckyTicky
Frequent Contributor (1K+ posts)
Member # 21466
posted
Oh, and mine weren't about IV abx though.. sorry
-------------------- IGM: 18+, 23+, 30+, 31+++, 34+, 39IND, 41++, 58+++, 66+, 83-93IND IGG: 31+, 39IND, 41+ Also positive for Mycoplasma Pneumoniae and RMSF. Whole family of 5 dx with Lyme. Posts: 1014 | From Texas | Registered: Jul 2009
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