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Vbakersimon

Best (and worst) insurance coverage for ABX for Lyme?

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Hi everyone,

 

We need to make our enrollment decision for 2014 and am wondering if we should stick with our current small business PPO plan (United Healthcare, which just raised our premium another 13%), or switch to BCBS or Aetna? We are a family of 4 and ALL of us are chronic Lyme patients on antibiotics. My youngest son also has CVID and has intermittent rounds of IVIG. Therefore, I'm nervous about potentially switching without knowing what we're getting into. My question for you:

 

- what is your experience with getting antibiotics covered for a LYME diagnosis under either Aetna or BCBS?

- what insurance companies would you stay away away from?

 

Any insurance feedback would be really helpful!

 

 

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Of the three, I only have experience with UHC, which I hate. We used to have Cigna and then that option was taken away and we've had UHC for the past 2 yrs plus one year about 5 yrs ago. I've consistently experienced more denials of coverage with UHC than with Cigna for the same services or things that should be a no brainer. We did have UHC for one year that my son was on combo abx for lyme and they covered those without issue, but then I live in CT where laws protect doctors who prescribe long term abx. They did deny the two months of diflucan for yeast despite several attempts by the doctor's office to re-code. So I had to pay $80 out of pocket each month, which was ridiculous. If I could switch back to Cigna, I would in a heartbeat. But if you know that UHC is covering things currently, you may not run into the issues I've had with them.

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We will have to get a new insurance too. Our DS Dr and another specialist said Obama Care will not allow psychiatric diagnoses to be treated medically ie getting antibiotics etc. The "standard of care" is to be separate based on coding. The FDA is also trying to pass laws against prescriptions from Canada. Anyone have any expertise?

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I've been happy with BCBSMA PPO. DD has been on many abx over the years for PANDAS, Lyme, Bart, MycoP, etc. and they have never questioned any (i.e., Augmentin XR, Azith, Tindamax, Doxy, Rifampin, Mino, Biaxin, etc.).

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BCBS PPO Michigan. Never had a problem. Long term abx, as in 3 yrs, no break. No questions asked, knock on wood. The coding on the lab slip is for infections and immune something or another.

 

Must clarify, my dh's employer is self insured and BCBS administers the program.

Edited by nicklemama

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