posted
Maybe someone here on Lymenet has more info and experience on your question.
I found this by googling, but I do not know if it is reliable or not. “Under most situations, drugs administered via IV are covered by Medicare Part A (if you are an inpatient in a hospital) or Part B (if administered in an outpatient clinic or in a doctors office). If the drug is self administered in your home the cost of the drug might be covered under your Part D.”
You could certainly try calling Medicare (1-800-633-4227) to find out,
or
Try calling your state’s health insurance assistance program for information: Massachusetts SHIP Website:
Program Name: The SHINE Program (Serving Health Information Needs of Elders)
About: The SHINE Program (Serving Health Information Needs of Elders) is a state health insurance assistance program that provides free health insurance information, counseling and assistance to Massachusetts residents with Medicare and their caregivers. The SHINE Program is administered by the Massachusetts Executive Office of Elder Affairs in partnership with elder service agencies, social service and community based agencies and Councils on Aging. The program is partially funded by the federal agency Centers for Medicare & Medicaid Services.
Posts: 873 | From WA | Registered: Dec 2005
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- In my state, if one qualifies for Medicare, they are required to have that as their primary. Medicaid would then become secondary unless they "give over" Medicare to a Medicare HMO.
This may not be in your state, however, if you have just recently qualified to be covered by Medicare, you need to be sure about this.
The tricky part is that the IDSA limits treatment to 28 days for lyme (whether IV or not). There can be some exceptions depending on coding, perhaps (and luck, say there is another diagnosis / infection for the IV and it just might cover several bases).
Any organization that is run by a state may also follow the IDSA's sharp "rules" - that may depend upon how lyme "aware" (or "hostile") the state medical board is, as organizations don't have autonomy, usually -- but sometimes, things can be done by stepping through a side door, so to speak.
Insurance companies, including Medicare, follow the IDSA guidelines, not ILADS. Of course, ask the LLMD who will be guiding this. Ask what their experience has been.
Secondary coverage to Medicare also matters. Some things with IV are covered by different parts of one's insurance.
You might talk to those in your area lyme supports groups who have the same coverage as you.
I would not talk to any insurance group you have or mention lyme at all if talking to any organization that may be of service. And if you call Medicare, they won't even talk to you unless you identify yourself.
Just don't raise any flags. If you mention any diagnosis in an inquiry, it will be noted in your chart, they do keep track of conversations. I found that out, by surprise. But, they could not keep track of when a doctors would summit a bill . . . they always said they never received it. Over and over, year after year.
Each state and even each region can differ in some services from Medicare, though. But, last I checked a couple years ago, Medicare's website even clearly stated the 28-day maximum treatment for lyme.
All this is just a caution as you proceed carefully. Some do manage but it's sort of hit or miss, it seems.
First, see what others in your support groups have to say about how they proceeded with similar parameters. Get a lay of the land. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
The last time I heard, it was just 28 days coverage for IV. You can call Medicare and ask.
Posts: 13171 | From San Francisco | Registered: May 2006
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Even with 28 days, the diagnosis of lyme may well have to be to IDSA tiered stipulations, meaning recent bite, recent onset of symptoms, with an EM rash,
and a positive ELISA first (which has very poor specificity), only then would a positive IgG Western Blot be required, too (and IgM ignored). All current, since they don't believe it can persist.
Once in a while, someone can move around that, though, so do ask around locally of others with lyme.
Ehrlichiosis (or Anaplasma) might stand a better chance of treatment (and use some of the same Rx), just in case that's on your plate, too. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Regarding a bill sponsored this past winter by one of Massachusetts' state legislators:
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The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
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