posted
So aggravated, I had it all written out and hit the back button and GONE forever. So a long story even shorter.
35 year old male, probable bite in '99, definite bite in 2006. Saw Dr. C in MO late in 2006 and started on orals.
Took orals for 3 years with improvement to the 80-90% mark. Periodically took orals until a year ago.
Symptoms came back slowly and am now am back at the beginning after a year of no abx.
Recently saw Dr R in MO for a different angle and had tons of testing done to find RMSF, Bart, Babs and awaiting classic lyme test from Germany.
She reccomended IV antibiotics, wich I agree. How does one really pay for this???? $1K a day basically.
I am self employed and have a cheap $100/mo 5k deductible 80/20 plan with AETNA. I can't get answers from them whether it is covered and can't get answers from the doctors office.
They both say they won't know until it is billed. Too much money to not know what is going to happen there.
Looking for other options/experiences to help me out. I do have a nurse practitioner and another RN in the immediate family, but both are blanked about lyme.
I anm not bashing either doctor by the way, both are very knowledgable people and have taught me a wealth of information in a very short time. I'm just ooking at my options.
THANK YOU!!!!!
***edited name of city . per LN rules***
[ 06-04-2011, 04:34 PM: Message edited by: Lymetoo ]
Posts: 20 | From Platte City, MO | Registered: Jun 2006
| IP: Logged |
posted
Even if a procedure or treatment is "covered" under your policy, the insurance company will ALWAYS say that "payment is not guaranteed". This gives them an out for denial of coverage which they love to do. You should always file an appeal for anything that is denied and it may take a couple of appeals. It can be as stupid as one number in the diagnosis code doesn't match the procedure code and they will deny it.
-------------------- Down on her knees, she wept on the floor. This hopeless life, she wanted no more. Dead in the mind and cold to the bone, She opened her eyes and saw she was alone. ~Seether Posts: 427 | From Rhode Island | Registered: May 2011
| IP: Logged |
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
The IV meds used to treat Lyme do not cost $1,000 per day! You can get IV ceftriaxone (Rocephin) and supplies for approx $600 per month.
If you need to go the IV route then I would highly recommend you compare prices before you decide on a home infusion company. Infuserve America often has the best price available.
quote:Originally posted by sammy: The IV meds used to treat Lyme do not cost $1,000 per day! You can get IV ceftriaxone (Rocephin) and supplies for approx $600 per month.
- The dr above requires that you have the infusions at her office. Big conflict of interest.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
| IP: Logged |
posted
I picked up my Iv meds at the pharmacy, saline bags, syringes, iv meds (but not mixed)
A whole month cost me $100. You have to learn to mix it yourself, but is quite easy. I was doing rifampin and something else-can't even remember what.
This is one route a lot of people don't know about. If you can get a friend who is a nurse, pharmacist, doctor, etc. They can teach you- yes, it was a little scary at first, but then you realize how much this stuff is and how easy it is to mix and I got ****ed.
I had a hickman catheter put in. Insurance did pay for this. (Most will) but they won't pay for the maintenance or the drugs. You have to find an infusion company who will change your dressing weekly. I used Walgreens infusion, $80 per visit so 320 per month.
My prescription plan is what payed for my meds.
It's the craziet thing=pm me if you need any more info-wish I knew about this before I shelled out 10 grand for my meds
Posts: 298 | From usa | Registered: Aug 2009
| IP: Logged |
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
| IP: Logged |
scorpiogirl
Frequent Contributor (1K+ posts)
Member # 31907
posted
I just started IV 10 days ago. From what I read I thought going out on my own to "price shop" and buy in bulk was the way to go. WRONG!! I couldn't get my insurance to pay a shiny penny for anything!!
So frustrated I called a home infusion care PHARMACY, and spoke to a very helpful Pharmacist. He said the only chance we have is to build up my case in such a way that they can't deny it. So he took all my blood tests, my treatment plan, my standing orders for blood test, etc... and made a case for me. Well lo and and behold... my insurance is paying for all supplies for my dressing for my Hickman Line, my flushes, my Invanz $3900/month and a visiting nurse!! He's NOT billing them thorough the pharmacy/meds coverage but rather through "Major medical". I don't know what that means but if you find a knowledgeable Pharmacist/Dr they will find a way to help you!! I'm just so thankful I called this particular place and found a compassionate Pharmacist, when the 20 others I spoke to prior could not or did not attempt to "hear" my story let a lot trying to help me!! So be persistent!!
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic