posted
I have been on 1 week of home administered IV infusion Rocephan and had 2 full days of pain free days, when my insurance coverage denied me any coverage for this treatment. They say I do not have a diagnosis based on CDC and that antibiotic treatment is not standard of care. I am facing $5,000 bills + to get the only treatment that has helped me over 3 long years of joint pain. The Advanced Lab spirochete testing showed positive for spirochetes. My llmd doesn't take insurance, but my primary physician is consulting with him to get the treatment plans for me. Is there any help out there financially to keep on the infusion drug? Running out of time and out of money.
Posts: 4 | From MN | Registered: Jun 2011
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
This happens to many people. Lots of threads on the subject.
You can appeal. This will take time, so you will need to arrange a different method in the meantime. Appealing means first to your insurance company. Find out how that is done. It should be in your plan description booklet. States also have another place to appeal if your insurance still refuses.
The way to get IV rocephin more affordably is to drop the infusion company, and buy your meds and supplies elsewhere. Then do it yourself at home. Many people have done this. Unfortunately there is no angel who comes along to pay for lyme treatment.
Contact a local support group in your state, as they will be familiar with this situation.
Posts: 2888 | From USA | Registered: Mar 2004
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-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
[someone should make a sticky out of this post, please.]
First appeal through all levels of appeal through your insurance co & your state.
State that the CDC criteria is for epidemiological use ONLY, not for diagnosis. It used to say that on the CDC website, If it still does, quote that. But say it anyway, even if it is no longer there.
Send your + test along with a letter of medical necessity from your LLMD or PCP.
Then, if it still doesn't work, file a complaint through your state Attorney General's office.
Then, if that doesn't work, which it often does, often you can buy the meds & supplies from Infuserve America (good prices & good company), have them bill your insurance company, and it they
pay them, they will reimburse you. Often the insurance co will pay (they won't tell you ahead of time that they will). It's not a guarantee, but it works fairly often.
LDA.org in their LymeTimes has a whole issue on insurance, which is well worth buying from LDA.org.
Go get 'em!
Posts: 3792 | From around | Registered: Mar 2008
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