Lyme Insurance Coverage Maryland

[filinha1]

Hello,

 

Does anyone have experience using Coventry to pay for PANDAS and PANS treatments in Maryland? Our LLMD prescribed zithromax and Coventry is requiring pre-auth for more than 4 pills. My questions are the following:

 

1. If I ask my LLMD to call in for the pre-auth, am I putting her at risk to be hassled or worse, by Coventry?

 

2. Are there laws in Maryland to allow treatment for chronic Lyme and co-infections?

 

Thanks for any input!

 

Heather

[mdmom]

I cannot answer your questions specifically about Coventry, as I have BCBS. However, here are a few things to consider:

 

1) Find out exactly what diagnosis your doctor will use for the pre-authorization. Is it for Lyme or another infection (strep, Babesia, Bartonella, etc)? Doc only needs to use one dx code.

 

2) I recommend that you avoid calling the insurance company yourself and mentioning Lyme or PANDAS - they will note this on your file.

 

3) Find out if your policy has a Lyme rider. If not, there should be less of a problem getting coverage for Lyme treatments.

 

With my daughter who has Lyme, Babesia and Bartonella, the doctor continues to use Babesia and Bartonella dx and generally avoids using Lyme as a diagnosis since she is not CDC positive. They have not questioned the other two dx and we have not gotten to treating Lyme at this point anyway.

[filinha1]

I cannot answer your questions specifically about Coventry, as I have BCBS. However, here are a few things to consider:

 

1) Find out exactly what diagnosis your doctor will use for the pre-authorization. Is it for Lyme or another infection (strep, Babesia, Bartonella, etc)? Doc only needs to use one dx code.

 

2) I recommend that you avoid calling the insurance company yourself and mentioning Lyme or PANDAS - they will note this on your file.

 

3) Find out if your policy has a Lyme rider. If not, there should be less of a problem getting coverage for Lyme treatments.

 

With my daughter who has Lyme, Babesia and Bartonella, the doctor continues to use Babesia and Bartonella dx and generally avoids using Lyme as a diagnosis since she is not CDC positive. They have not questioned the other two dx and we have not gotten to treating Lyme at this point anyway.

 

Ok - thanks for the advice! I'd never even considered a Lyme rider, but I'll look into it.

[tpotter]

Hello,

 

Does anyone have experience using Coventry to pay for PANDAS and PANS treatments in Maryland? Our LLMD prescribed zithromax and Coventry is requiring pre-auth for more than 4 pills. My questions are the following:

 

1. If I ask my LLMD to call in for the pre-auth, am I putting her at risk to be hassled or worse, by Coventry?

 

2. Are there laws in Maryland to allow treatment for chronic Lyme and co-infections?

 

Thanks for any input!

 

Heather

 

 

It might be easier, and just as inexpensive to get your azith at Costco. We get it for our dog, and it costs us around $10 per month! In fact, we get all his meds there, because they are not covered by insurance, and there's another that costs over $100 everywhere else, that only costs $11.00 at Costco.)

 

Yes, I do think it might put your LLMD at risk of being hastled, but in the end, it's up to your LLMD.

 

Good luck.