posted
I am wondering if anyone has had consistent success in NY or CT with their insurance plan getting full or partial coverage for their long-term treatment. I know most people will say it depends on many factors, and it is hard to give a definitive answer, but I am just asking if in anyone's specific case they've had their medications and treatment covered on a regular basis. I ask about both NY and CT because I have a parent living in both, so I could claim residence in either one.
Are there any companies/plans with a reputation for denying most coverage or any with a reputation for covering more than usual for lyme? The abx I'm talking about are things like IV Rocephin, Mepron, Zithromax, Biaxin, Bicillin, etc.
I used to be insured by Anthem Blue Cross Blue Shield in CT and they covered a very large portion of my visit and abx expenses - unfortunately I couldn't pay for a month and they denied my resubmission. I now have United Health Care, but the deductible is very high and I have heard they aren't great about lyme coverage. Can anyone confirm this? I don't want to pay the large deductible if the best option is to switch to a different company.
It is my understanding that only PPO plans cover out of network specialists, and since I plan to see an ILADS specialist who doesn't take insurance, I guess PPO is the only way to go. If it helps at all, I am trying to see Dr. H in NY. If anyone has had particular success getting coverage for his treatments, that would be very helpful as well. Thanks so much. I know insurance is one of the toughest issues we have to deal with, and nothing is clear-cut, but any and all help would be much appreciated.
Posts: 9 | From Connecticut | Registered: Sep 2010
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Unfortunately he doesn't take any insurance. You might be able to get reimbursed, but you'd need to have an out of network benefit on your plan. Just because you've got a PPO plan doesn't mean you've got that benefit.
I just pay for my office visits out of pocket. All my prescriptions are covered, and if i need blood work done i'll have them write a script to have it drawn at a local quest labs - so that's covered too.
Posts: 339 | From Outer Space | Registered: Aug 2009
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
You're much better off getting coverage in CT for Lyme treatment, as by law in CT insur co's have to pay for Lyme treatment. But you should still check out everything, as there are many ins and outs.
United Health Care/Oxford only pays for 28 days of IV tx. But they probably have to pay longer for IV in CT.
I thought PPO meant that you could see out of network drs? Maybe not always.
Another factor is sometimes if you dr is out of state, you have problems with getting the nursing agency to accept dr's orders from out of state. Although since CT is a neighboring state, they often accept that.
Chose carefully, as there is lots to consider here! Look carefully at whether they cover IV tx, what their medication coverage is, etc. But the CT law is a godsend for Lymies who live there!
Posts: 3792 | From around | Registered: Mar 2008
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