posted
I'm sure people have run into this before so I'm wondering what my options are, if any, now that my Insurance will no longer cover my Abx.
The original Rx was written by my LLND to include 60ct of Zithromycin. They quabbled with me when i went to pick it up and said that my insurance would only fill 36ct (standard Zith courses are 5 days of 1/day).
my LLND Said she would just write another Rx when i needed one and, she did, but they denied it entirely this time.
If i want to pay out of pocket that's $85 for 36ct (18 day supply). And, that's over $150/month for JUST Zith, nevermind the Bactrim (which i'm sure I will run into the same issue) and my supplements, etc.
What are my options here? Do I have a leg to stand on if I call my Insurance?
They're rather quite crappy Insurance (Cigna Health Care, through my Wife's work - a Hospital no less...)
Thanks for any and all insight, it is much appreciated!
I have a call into my LLND but she is not as responsive as I need her to be since i have 1 Zith left for tonight :|
Posts: 47 | From NH | Registered: Oct 2010
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- I can't address matters of insurance but if you have only one pill left, I would get both allicin and olive leaf extract to tide you over. It's good to have both of those on hand, anyway. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Most Insurance Companies require that your doctor fill out and fax paperwork to them that states that it is necessary blah blah blah.
Call the company and have them fax the paperwork to your doctor to get the ball rolling. Then call your doctor and tell them to expect it. You will have to babysit the paperwork in order to get it through the system.
I found many times that the paperwork would get lost either to my doctor or from my doctor to the company. I finally had my dictor's office give me the paperwork and I faxed it to the insurance company.
The company said they never got it. I called them and asked if they got MY fax with the doctors paperwork and they said no. I informed them that I now had the doctors paperwork and could sit here all day and fax it to them hundreds of times if necessary. They got it the very next time I faxed it.
You must be persistent but most insurance companies will approve it if your doctor will jump through their hoops. They hope that your doctor won't.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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17hens
Frequent Contributor (1K+ posts)
Member # 23747
posted
Don't know if this will help any, but...
When my insurance stopped allowing me Diflucan (the generic Rifobutin actually), I asked my pharmacy how much it would be if I paid out of pocket.
Their price was $132 for 30 days.
I called Costco and their price was $23. No contest. Don't have to be a member to use the pharmacy.
-------------------- "My flesh and my heart may fail, but God is the strength of my heart and my portion forever." Psalms 73:26
bit 4/09, diagnosed 1/10 Posts: 3043 | From PA | Registered: Dec 2009
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littlebit27
Frequent Contributor (1K+ posts)
Member # 24477
The first one has been better for me. But sometimes it's hard to get it to come up to print. I had to email it to myself and follow the link from there.
I pay 43$/month for biaxin.
Diflucan I pay a bit more for that 17 but the closest costco is 1 hr away so I'd waste more gas money driving there.
I pay 11$ for my 90 ct of pain killers. 11$ for a month of bactrim.
Discount cards have saved my wallet, and my life. Because without them I wouldn't have gotten any meds at all.
sixgoofykids
Honored Contributor (10K+ posts)
Member # 11141
posted
When my insurance declined zith I took biaxin instead. Similar drug and doesn't require prior authorization.
-------------------- sixgoofykids.blogspot.com Posts: 13449 | From Ohio | Registered: Feb 2007
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seekhelp
Frequent Contributor (5K+ posts)
Member # 15067
posted
Yeah Bactrim for 7-10 DAYS, not LLMD's dosing of months at a time!!!!!!! Sorry, there are quantity limits on these $4 drugs. That said, it's still a very cheap drug since it's been out forever.
I agree with Six. Biaxin is a better choice, cheaper and less argued by insurance. I had the same issues with Zithromax, but insurance covered Biaxin w/o issue. There's something they don't like about long-term Zithromax.
quote:Originally posted by littlebit27: And bactrim is on many $4 lists so it doesn't end up being that much at many pharmacies, like Kroger or Walmart.
Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
Can you go herbals?
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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ktkdommer
Frequent Contributor (1K+ posts)
Member # 29020
posted
My sister's doctor is writing her antibiotic scripts for babesia and bartonella diagnosis and not mentioning anything about Lyme. This may be an option,especially if you have an insurance company with a strict Lyme treatment policy.
-------------------- Things are never dull. After 3 fighting Lyme, 2 are in remission. Youngest is still sick, age 22. He has new diagnosed Chiari Malformation and Ehlers Danlos Syndrome. Posts: 1366 | From Perrysburg, Ohio | Registered: Nov 2010
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posted
Thanks so much for all of your quick and insightful replies!
I contacted my insurance and the reason it was denied was due to quantity.36 was the most thy would fill before requiring an authorization, which ny doc has to call in for. I contacted my LLND to have her call in the author and we will see how far that gets me .
In the meantime I will take my oil of oregano and bacteria, and sign up for one of those discount cards I've been meaning to do that anyways.
Thanks everyone I will keep u posted. Merry Christmas and happy new year!
Posts: 47 | From NH | Registered: Oct 2010
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Thanks for the replies everyone. Well, the authorization FINALLY came back today, and the wait was well worth it as it was...
DENIED.
What did I expect really? It was denied because of the Lyme Dx, so I'll have to pay out of pocket ($80 for 72ct = 1 mo supply).
One poster suggested to spread the Rx out to a different pharmacy... but I dont think it will work since it's already been denied? It's not the pharm that is denying, it's Cigna (PS - they have been NOTHING but a HASSLE...absolute nightmare, even prior to this whole Lyme dealio).
So, I'm gunna fork the $80 for now to get back goin on the meds, but i'll be on the lookout for cheaper options. I dont want to sacrifice quality however, so if anyone has a good reliable source i'm all ears.
Thanks for your replies. Much appreciated.
Posts: 47 | From NH | Registered: Oct 2010
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sutherngrl
Frequent Contributor (1K+ posts)
Member # 16270
posted
Like Lymetoo said, could you try another antibiotic? I've had the best luck taking doxycyline AND its very very cheap.
When I took 4 months of zith, my LLMD wrote on the script that it was specifically for LD and they allowed me to get a prescribed months worth at a time. Did your doc make it known what the zith was for?
Posts: 4035 | From Mississippi | Registered: Jul 2008
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