Insurance not covering Bicillin

[matis_mom]

I was so happy our LLMD to come home with a script for weekly shots for dd. I tought, "great, will just get them at the pharmacy and dh can do the honors!"

Well, our insurance for some reason will cover none of it, and it's not cheap...

Has anyone had this?

I call but the system is down so they can't help me until Monday...

[NancyD]

This is what I find so frustrating. First it takes years to finally get a diagnosis and then when the doctor prescribes something that will work the insurance companies won't cover it. I just looked up our insurance online and here is what it says about IV abx:

 

"Harvard Pilgrim will reimburse for the use of intravenous ceftriaxone, cefotaxime, or penicillin G (for up to four weeks) for the treatment of chronic or recurrent Lyme disease. Prior authorization is required for outpatient, office-based, and home infusion services provided to members enrolled in our HMO, POS, and PPO products.

 

Harvard Pilgrim does not reimburse for the use of parenteral antibiotics beyond four weeks, as there is no evidence indicating that such use is beneficial in the treatment of chronic or recurrent Lyme disease. We also do not reimburse for parenteral (IV or IM) imipenem-cilastatin, ceftazidime, cefuroxime, vancomycin, bicillin, or ampicillin for the treatment of early or late disseminated stages of Lyme disease, as there is no proven role for the use of these agents. It is recommended that use of these antibiotics be avoided, too, as prolonged use may encourage community-based resistance."

 

So mine will cover for one month only. Have you checked online to see what your insurance guidelines are with respect to LD?

 

Nancy

 

I was so happy our LLMD to come home with a script for weekly shots for dd. I tought, "great, will just get them at the pharmacy and dh can do the honors!"

Well, our insurance for some reason will cover none of it, and it's not cheap...

Has anyone had this?

I call but the system is down so they can't help me until Monday...

[matis_mom]

This is what I find so frustrating. First it takes years to finally get a diagnosis and then when the doctor prescribes something that will work the insurance companies won't cover it. I just looked up our insurance online and here is what it says about IV abx:

 

"Harvard Pilgrim will reimburse for the use of intravenous ceftriaxone, cefotaxime, or penicillin G (for up to four weeks) for the treatment of chronic or recurrent Lyme disease. Prior authorization is required for outpatient, office-based, and home infusion services provided to members enrolled in our HMO, POS, and PPO products.

 

Harvard Pilgrim does not reimburse for the use of parenteral antibiotics beyond four weeks, as there is no evidence indicating that such use is beneficial in the treatment of chronic or recurrent Lyme disease. We also do not reimburse for parenteral (IV or IM) imipenem-cilastatin, ceftazidime, cefuroxime, vancomycin, bicillin, or ampicillin for the treatment of early or late disseminated stages of Lyme disease, as there is no proven role for the use of these agents. It is recommended that use of these antibiotics be avoided, too, as prolonged use may encourage community-based resistance."

 

So mine will cover for one month only. Have you checked online to see what your insurance guidelines are with respect to LD?

 

Nancy

They are updating their system and it's down until Monday, so maybe that is why it got bumped? But the other five prescriptions went through...

I can't access my account, nor can anyone help me on the phone until the system is back up. I thought I would be saving them $ by just doing them at home!

[matis_mom]

So we got a hold of our insurance co. Apparently, it's not covered under prescription plan, but it IS covered under medical. So we would have to either have it done at the hospital's infusion center, or order the shots throught their mail-in plan. Something to keep in mind if anyone else runs into this.