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Drug Insurance Coverage and Lyme Treatment

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Lyme Disease
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Posted 3/27/2013 6:42 PM (GMT 0)
My wife has cronic Lyme and is being treated with various antibiotics by her LLMD. We have group insurance (UHC/Medco) through my employeer. The drug plan refuses to pay for any antibiotics for the Lyme treatment. They did pay for the first month or two and then refused any further payment. My wife's doctor appealled to no avail.

My wife was recently granted disability which is great news (thanks to the great documentation her doctor provided). Our decision now is, she now qualifies from Medicare. Do we want to take it or stay on my employer's insurance policy? In trying to make that decision I contacted a Medicare Part D Rx provider (AARP MedicareRx Enhanced) to try and determine whether or not they will cover ABX for Lyme. The representative said that if the medication is medically necessary to maintain the standard of life (and the patient's doctor is the one to determine this) then the medication will be covered. I would be shocked if this were actually the case. I imagine that if we join and after we try and get the ABX covered that they will say that the CDC does not agree with the use of long term ABX and they will refuse to pay just as Medco has.

Is there anyone on the forum with long term Lyme that is getting all ABX paid through a Medicare Part D provider?

 

Posted 3/27/2013 6:58 PM (GMT 0)
Sorrry, not sure. I know that my Lyme doctor takes Medicare. There are a lot of people that are on antibiotics long term....doxycycline is used for acne...ACNE. Crazy, isn't it?

Check your email, I sent you a message.

Posted 4/3/2013 8:45 AM (GMT 0)
I am on disability and I get my antibiotics approved through AARP Uniteh Healthcare , you can email if you wish to further discuss!!!!
Posted 4/3/2013 10:46 AM (GMT 0)
Usually oral antibiotics are covered if patients get them month to month (and don't try to order 90 days supplies through mail order). Most people don't tell the insurance company that they are treating Lyme because that raises red flags. They will not cover long-term antibiotics for Lyme, but most times if you don't draw attention to it, orals go through.
Posted 4/3/2013 11:12 PM (GMT 0)
Summer3,

We told our insurance company (BC/BS) that our daughter had Lyme. Everything was fine for the first couple of months. Then they started to give us a hard time. One of the ways that they made it difficult was to only allow prescriptions for Azithromycin to be filled for 5 days at a time. There were many telephone discussions and paperwork submissions, and we eventually gave up and didn't file for any more reimbursements.

Don
Posted 4/3/2013 11:53 PM (GMT 0)
Yes, I wouldn't recommend telling any insurance company that you have Lyme. That's a common problem with zith. They did the same thing to me. I had to pay OOP for that or switch to Biaxin.
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