posted
Is anyone running into the problem of BCBS (I am in Illinois) not covering IV antibiotics anymore after 30 days? I have been on it since last January so if so this is new. What are you doing if you are having this issue? Pulling the PICC was not in my plans but paying out of pocket is not really an option.
Are there other oral options that would be equivalent to Rocephin (I am up to 4 grams)?
Posts: 76 | From IL | Registered: Oct 2010
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
The closest oral you can get is brand name Septra, there is no generic for it. Very expensive antibiotic. You may be lucky and your insurance may cover it.
I ran into a similar problem with Anthem BCBS. They gave a prior authorization to my doctor's office and the infusion company before I started the IV antibiotics. So they had no worries about payment.
Me, I was worried to death because I knew in my gut if BCBS changed their mind I would be stuck with a huge bill that I could not pay....
Flash forward... I was on the IV Rocephin for about 3mo. Got a phone call one day when I was at work, my infusion company was no longer going to sent out my medication and supplies. They discovered that BCBS had not payed them for 7wks of treatment.
They held me responsible for the 7wks (~ $9,000) of antibiotic therapy that BCBS decided was not "medically necessary" and refused to cover.
I tried to appeal with the help of a lawyer and the full support of my LLMD and many other specialist MD's. The case went on for 2yrs before it was finally denied.
Lesson learned the hard way. I'm telling my story so that others don't go through what I did.
APMOM, I wish that I had known about Infuserve right from the start. The cost of their Rocephin and supplies was cheaper than my original copay through the infusion company! Give them a call and talk with them. They may be able to help you stay on the IV therapy that you need, even if just a little while longer.
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Actually, for most insurances that will even cover lyme 28-30 days is usually the max time for lyme treatment, anyway.
You might contact the Rx manufacturer about a donation program for Rocephin.
Years ago, I was "awarded" months of donated IV Rocephin.
I had to give it up, though, because I could not afford the have the line put in - or the tubing, supplies and nursing care to make that happen. My shoestring did not stretch that far.
If you can handle that part of it, perhaps with donated Rx, this could still work.
Your doctor would simply apply for you with the company and the Rx would be sent to their office for you to receive.
If it works that same as it did. It's worth asking.
It's very hard to be so close and have doors slam in your face. I hope some open up into very nice bright spaces for you. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
Thank you for sharing, your story is exactly what I am scared of and why I am hesitant to take the chance with a new company even if they say insurance is fine???
I have used infuserve during the beginning of the year while we are trying to meet our deductible and for glutathione and Myers cocktails etc., but even just under $1000 a month is too much right now. Figures right when the gallbladder has to come out because of the Rocephin I will have it taken away from me too, gotta love the irony.
Posts: 76 | From IL | Registered: Oct 2010
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gmb
Unregistered
posted
You might want to consider IM Rocephin. See if it is gcovered under your regular Rx plan (not medical). A 30 day supply of the generic Rocephin should cost no more than any other generic drug.
posted
Uh oh, I just started the rochephin last week and have BCBS... I have no clue whether they will approve it or not! I was sliding backwards quickly though so I decided to get started on it right away anyway. I'll cross my fingers, and in the meantime check out those other options in case they don't cover it.
-------------------- Wendy Posts: 253 | From Near Albany, NY | Registered: Jan 2009
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Keebler, thank you, I was hoping BCBS would continue to be "one of the good guys" as far as IV, but it isn't looking good. I have been on IV since January 2011 so I should be grateful it got covered this long I guess, just wish this was because I was ready to be off IV not because of insurance. I will have to look into calling the RX company and see if there is a chance they will help me, thanks for the tip.
Wendy, I will keep you updated, but you may want to be careful. Sorry you are in the same boat. Infuserve is a great company if you can swing it paying cash though!
Posts: 76 | From IL | Registered: Oct 2010
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gmb
Unregistered
posted
Yes... IM Rocephin is a shot. I would have been $10 a month for 30 vials, I didn't price the syringe or needles.
I looked into this as an option, but took risk and changed BCBS to more expensive plan for the year.
In RI, BCBS must cover the IV costs as long as Dr requires the treatment. Its probably the only good thing worth living here.
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posted
I have Anthem BC. I have been on IV antibiotics since last June. They paid for 4 months last year...I contacted my infusion co. 2-3 months after I started, and asked them to give me an out of pocket price for the IV azithro and supplies just in case the insurance co. stopped paying. I got a quote of $10 per dose for the drug and $10 per day for supplies. $20 per day, or approx $600 per month was affordable for me as, after 6-7 months, my ALS type symptoms began to resolve, and I have felt WONDERFUL for the last 3 months.... I don't know if I'm cured, I will try to wean off the meds next month, and pray my symptoms do not return as I wean from IV, but for now, I feel healed..... Just wanted everyone who is scared of being stuck with these huge bills know you can negotiate ahead of time with your infusion pharmacy.... and it has saved me $200 a month not using Infuserve America because I don't pay for overnight shipping....
Just FYI....IV has worked for me after little luck with orals for over 4 years......
Posts: 143 | From Louisville KY | Registered: May 2010
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
ALWAYS contact your Attorney General's office if you are having problems like this. Some have been VERY helpful in resolving these issues, but they MUST keep hearing there is a problem so they know where to allocate their funds to do the public the most good.
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