posted
Sorry for the newbie question but I'm new to all this and I did not find anything with a search.
When an LLMD (who does not take insurance) prescribes an antibiotic, is it covered by a prescription plan (if you have one with your insurance company)
Thanks for your help...
Posts: 5 | From PA | Registered: Sep 2009
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
If you have an HMO, then probably not unless you have an option to go out of network. If your insurance company lets you see out of network doctors then they should cover prescriptions if the prescription is covered at all. Some prescriptions are not covered, period.
Best to call your insurance company and ask just to make sure.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
For my insurance, prescription coverage is separate and covered even if the MD does not take insurance. check your coverage. We also submit the LLMD bills to health insurance and they pay the 'normal' in-network rate for the service. On mine, pays about 2/3 of the bill. Of course, no coverage for supplements, probiotics, etc.
Posts: 126 | From MD | Registered: Mar 2009
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
josh, all of my lyme treatment medications were covered by my insurance, even though the doctor was not covered.
Also, I paid the doc and then submitted the bills to my insurance and I got some reimbursement.
I wanted to let you know that some of the lyme treatment medications are REALLY expensive. For example, Mepron, which is used to treat babesiosis.
Before getting these expensive prescriptions filled at a local pharmacy, you want to find out if your insurance plan has a mail order option for prescriptions. If it does, you can literally save thousands of dollars on these expensive medications.
So, any time you take a prescription to the pharmacy and find out your copay is really really expensive, then it is time to look into mailing that prescription to your insurance plan and getting that particular medication through the mail for a very, very low price.
I never bothered with my mail order option until I ran into these extremely expensive prescriptions. Through the mail, I can get a 90 day supply of a generic med for $10 and a name brand med for $65, regardless of which medication it is. Even if it costs $1,000, I still get it for the $65 mail order copay. Can't beat it!
Posts: 9931 | From Maryland | Registered: Dec 2007
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