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How did you get IV approved by insurance?

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Posted 3/29/2010 7:12 PM (GMT 0)
Well the doctors had their little meeting and upheld the insurance co decision that without a positive lyme test, that the IV is experimental and/or not medical necessity.  I am wondering if everyone who had IV had either a positive blood test or spinal tap?  I have a call into the insurance company nurse case manager to see if they will accept blood work by Igenex and try and get my doctor to order that to see if it comes back positive before succumbing to the spinal. 

OR do I wait it out and see if it is just a flare? 

Since I have lesions on my brain, will the zithromax make any headway with neurolyme?? or is IV only the only treatment for neurolyme?

As always, thanks for any help.

 

Posted 3/29/2010 8:08 PM (GMT 0)
There is an appeal letter that was written that covers all the details needed to get approved by the insurance company. I'm not saying that this letter will definitely get you approved, but it does help patients that have a negative Lyme test. Give me a few days to hopefully find it. I've been under the weather so it may take some time.
Posted 3/29/2010 8:16 PM (GMT 0)
O thank you so much. Feel better!!!!
Posted 3/29/2010 8:25 PM (GMT 0)
Do you know if they will recognize/accept Igenex? I am looking to go that route as I have never had more than 3 bands through lab corp. but tested positive for coinfection through Igenex. Unfortunately dr. did not run lyme at the time cause he said the three bands I had were definitive enough. Ugh.
Posted 3/29/2010 11:24 PM (GMT 0)
Hey hun. email me with your email address. I found the appeal letter.
Posted 3/30/2010 1:26 PM (GMT 0)
This is just not fair for some of us. I only had 3 bands and was CDC positive. Not sure how

that worked and why it is considered positive, I recieved calls from my local health dept.

and the State Dept. So I guess in KS they consider 3 bands to be positive. Dosent make

sense to me but sure am glad I got the IV meds when I did.

Keep fighting this. My husband went into the insurance office and had it out with them

and told them they better do something because he was not going to sit back and watch

his wife die. It sure feels like a slow death at times. But Keep fighting it will get better, it

takes time and more time. It would maybe help if you could call the insurance company yourself.

Just a thought, do what you have to, to get what you think will help in your treatment.

Good Luck

Posted 3/31/2010 2:53 PM (GMT 0)
It's a terrible state of affairs for all of us! In BC, Canada, it is unlikely that you will get IV antibiotic treatment, period. Apparently, you HAVE to have a positive ELISA (Isn't that great? An unreliable test for a clinical diagnosis!), AND, even with a positive ELISA, the ID Specialist will unlikely agree that you have Lyme disease. In the past few years, I have stumbled upon maybe a handful, at most, of Lymies who were given IV treatment.

Everything about Lyme disease sucks!

Cara
Posted 3/31/2010 11:34 PM (GMT 0)

CajunGrl said...
Hey hun. email me with your email address. I found the appeal letter.

Hi CajunGrl,

I emailed you asking if you would please send me a copy of the appeal letter too....did you get my email?

Thanks,
JoAnn
Posted 4/1/2010 7:51 PM (GMT 0)
nasalady,

I received your email. I sent you something back:)
Posted 4/1/2010 8:51 PM (GMT 0)
Thanks so much, CajunGrl! What a great letter!!
Posted 2/16/2012 2:08 PM (GMT 0)

CajunGrl said...
There is an appeal letter that was written that covers all the details needed to get approved by the insurance company. I'm not saying that this letter will definitely get you approved, but it does help patients that have a negative Lyme test. Give me a few days to hopefully find it. I've been under the weather so it may take some time.

X
I have been denied by my insurance for IV tx and I tested positive on the western blot. If you have the letter you're referring to I'd really appreciate a copy...Lola
Posted 2/16/2012 2:47 PM (GMT 0)
Yeah, unfortunately for a lot of us, IV just isn't an option. I'm in Canada as well, and the only people I know who have IV paid out of pocket. I did meet one girl who claimed the cost of the IV back through health insurance and got it covered- but then got a notice that she had exceeded her maximum claim amount for the year, and they wouldn't cover any of the antibiotics.

I know that some LLMDs think that orals can be just as effective as IV, and don't use IV at all, unless people are getting much sicker really fast when they first see the doctor, or if nothing else is working.

I had some pretty bad neurological symptoms- huge memory problems and brain fog. They improved on oral antibiotics.
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