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Picc line and insurance

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Posted 11/19/2014 9:35 PM (GMT 0)
Because of major GI issues I can no longer tolerate oral antibiotics. My LLND is filling out paperwork for a picc line for the insurance company. He said that most insurance companies denies claims for this type of procedure. Has anyone had luck having insurance pay for a picc or port? How did you get them to cover it?

Any and all suggestions are greatly appreciated.
Posted 11/19/2014 9:41 PM (GMT 0)
Hello! My daughter had a Picc line with IV antibiotics this summer and the insurance company covered it with no problem. They even covered the two weeks he added on at the end. I paid a very minimal amount as a part of my deductible. We were very lucky.

My doctor was very thorough with bloodwork through Igenex and another lab, and his clinical diagnosis from her visits as well as the fact that she had been on orals for 3 months with little to no improvement. My doctor called the lab and the lab actually got approval from the insurance company. I had a Picc years ago to treat my Lyme and co infections, and also had no problems getting it covered by the insurance.

Good luck with it. The IV really did help me and my daughter.
Posted 11/19/2014 9:43 PM (GMT 0)
Hi Mom—

I read your other post about your kids. I am so sorry that lyme has inflicted your entire family but it is good that you know what you are feeling with—or at least have a good starting point. I'm sure others will be right along to make suggestions about herbal protocols.

I've used Byron White formulas with success for Bartonella and Babesia but not sure what to tell you about administering to your older kids. At first I thought the taste was pretty bad but I started to—"like" is not the right word, but it's like my body started to appreciate it somehow and I did not mind the taste AT ALL. Weird. But you have to take the herbs alone with water so there's no opportunity to mask it. Maybe there are other protocols that have more options for you.

Regarding the IV approach—please check out this recent thread of mine. I had a port installed 11/3. It has been an interesting journey so far but the meds are effective. I, too, have horrible GI problems-my worst symptom and I was willing to do ANYTHING to avoid making them worse. I was so bad I wasn't eating because I literally could not tolerate food so it was critical to work around it somehow.

www.healingwell.com/community/default.aspx?f=30&m=3233665

Please continue to post and let us know how things are progressing.

-p
Posted 11/19/2014 11:44 PM (GMT 0)
Dtav, does the ins company give you a deadline on when they stop covering?

Pirouette, I'm not happy about the kids. While talking with the dr today, we came to the conclusion that I had Lyme before I became pregnant. I took everything I had to not cry. The dr doesn't have children so I don't know if he truly gets the guilt a parent feels. I may have also given it to my husband as well.

I read your post about the port. How did you get the ins company to cover it?
Posted 11/20/2014 12:34 AM (GMT 0)
I had absolutely no issues getting 30 days coverage. But my insurance plan is one of only two my LLMD participates in. I didn't ask her this but likely, the reason she chose these plans is that she has been able to work well with them.

Initially, I was very concerned that I would start the IV and then after 30 days not get further coverage (she has advised me that I will likely be in treatment 18 months or so but likely will be on abx less time than that but it's still a long-term treatment plan).

But when the first delivery of the syringes came (I inject 1 per day for 5 days/wk), all five indicated "99" refills, which I think would be about 10 months Rx. However, I know that she will be increasing the dose so, I don't understand it but that is on par with just about everything else I've experienced with this insurance company. We'll see what actually gets covered when I get the notice that something isn't covered.

My suggestion would be to speak with your LLMD about it again. Let him know that you've done some research and there is precedent for skipping the orals and starting with IV due to GI issues and ask him to advocate with the ins. co. on your behalf. He might need to prove your GI issues and hopefully your records sufficiently document this.

I have read other's posts over the past year since I joined who could not get coverage and they ventured on their own with independent contractors who could supply/deliver the meds. I'm not sure how they obtained an Rx (or if they needed to, likely they did) and it is a more expensive option. I've read that some people are paying $1000/wk for the meds. I'm not sure how much mine are running but I'm on a low dose right now.

-p
Posted 11/20/2014 12:38 AM (GMT 0)
Also—
I am just so sorry about your family. There is no way of knowing how you could have infected them. You simply couldn't have known. But that is why it is IMPERATIVE that the issues with contraction are eventually widely published but I fear it's going to be too late by the time this happens.

What matters now is that you are taking action, educating yourself and you've sought the right treatment. You have tons of support here, too. Keep posting...

-p
Posted 11/22/2014 11:19 AM (GMT 0)
Insurance will only cover 30 days? I don't even know how long I will have to have it. I guess I will take one day at a time. He he, not like I have a choice.
Posted 11/22/2014 4:29 PM (GMT 0)
My insurance covered for 6 weeks, and would have extended it if her blood work warranted it but it did not. She had to come off and go back on orals for 90 days before they would consider it again.

Good luck with it.
Posted 11/22/2014 6:11 PM (GMT 0)
What blood work is done to see if it warrants more meds? My GI system does not tolerate oral antibiotics.
Posted 11/23/2014 1:32 AM (GMT 0)
Mom—

I am not sure why my insurance would only cover 30 days but that is what my LLMD told me. However, I noticed the other day that the refills indicated on the meds are for nearly 10 months of Rx. I was shocked. I'm not banking on it and I'm assuming there was a mistake. We'll see.

My LLMD did not do any bloodwork (other than IGeneX WB for the lyme) but documented my long-term complications from going untreated for almost two decades and she also anticipated that I might have to see a gastroenterologist to rule out mechanical problem (and to be honest, to further document the GI problems) but I didn't have to do that. I'm not sure why—maybe it's because my Dr has established precedence w/ the insurance company with previous patients?

-p
Posted 11/24/2014 4:38 AM (GMT 0)
Mom
I have a PICC, and my doc got the auth from insurance without a problem. I did not even have a CDC positive blood test. I was very adamant that I wanted one. However, they only covered 30 days. I am currently on my own. Good luck!

Pirouette
How did you get them to pay for a port instead of a PICC? I wanted a port because I heard they are better for long term use. My doc said not to push my luck :-(
Posted 11/24/2014 3:15 PM (GMT 0)
I had a picc line covered by insurance last year. They covered 30 days of meds. At the time I was herxing so bad I thought meds weren't working so I never tried to get more. Especially at $2500 a week. In hindsight I wish I did more. I got much better a week or two after the iv stopped. I'm now on iv again. This time I'm using infuserveamerica. The cost is less than $200 a week for the meds. You just need to get your own nursing service. Just Google iv nursing. I'm paying out of pocket for this. It's pretty reasonable considering the expected benefits.

The only difference is these iv balls infuse over 60 minutes and the ones from last year infused over 30 minutes.

I did three doses do far and I really think I'm herxing already. All my symptoms have become more pronounced. While it sucks that it's around thanksgiving I am hoping that it will be worth it for Christmas time.

Post Edited (Daxwell) : 11/24/2014 8:59:58 AM (GMT-7)

Posted 11/24/2014 3:46 PM (GMT 0)
IV coverage for Lyme patients varies greatly from state to state, and sometimes across carriers within the same state, and weather or not you are CDC positive. It shouldn't have to be this difficult.

InfuServe America in FL has some of the lowest direct rates available at around $750 per month for Rx and supplies, shipped on a weekly basis.
Posted 11/24/2014 9:48 PM (GMT 0)
I too use infuserv and am very pleased. what a difference between what agencies charge and online infusion companies charge.
Posted 11/25/2014 10:17 AM (GMT 0)
I should be finding out by next week. My thought is, If I can not tolerate oral abx they would have to find/use another alternative. Spending $750 a month on just me is not something I really want to do. With the whole family having Lyme, it's just too expensive.
Posted 11/25/2014 2:43 PM (GMT 0)
Mom of 2, the cost for me is $720 for the medicine plus you still need to have the line inserted. I just paid a local IV nursing company $350 for the line. Then, I am paying $135 for them to come out and change the dressing. You can try and change the dressing yourself, which has to be done weekly, but i don't think it;s worth the risk of contaminating something. I am hoping that my insurance will pick up the nursing the fees. My doctor said he has seen this before where insurance pays for the nurse, but not the meds. Nothing about insurance makes sense.
Posted 11/25/2014 5:58 PM (GMT 0)
Mom of 2,

The Lab that handled the IV did blood every week. Not sure of everything they checked aside from wbc, rbc etc but one thing was for Lyme. Again, blood was done through LabCorp so I don't know how accurate Lyme test was, but that is what insurance company used as a guide.
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