- This topic has 8 replies, 4 voices, and was last updated 9 years, 5 months ago by
.
-
Posts
-
As if lyme is not enough, my insurance and providers are given me hard time now.
I started seeing an LLMD a couple of months ago and after receiving some ABX treatments I got prescribed Rocephin 12 IV treatments (3 a week) for a month, for lyme. (IGX positive, CDC negative)
My insurance doesn’t not want to pay, even after receiving my medical files, because they state it is experimental, and on top of this the provider is out of network. If the treatment costs would have been reasonable it would not have been such a problem, but the provider charges the ‘criminal’ amount of 9000 for each IV, which I only found out after receiving all treatments.
I have done a last IGX report which (lucky me) now shows alse positive Lyme according to CDC. I hope the insurance will recognize this. Still I have a 20% of 9000K x 12 treaemnst hanging above my head for the out of network situation, which, again, is outragious. My insurance has not yet received, I believe, that last IGX report.
Advise how to deal with this situation is appreciated.
Thanks!
@Karel wrote:
As if lyme is not enough, my insurance and providers are given me hard time now.
I started seeing an LLMD a couple of months ago and after receiving some ABX treatments I got prescribed Rocephin 12 IV treatments (3 a week) for a month, for lyme. (IGX positive, CDC negative)
My insurance doesn’t not want to pay, even after receiving my medical files, because they state it is experimental, and on top of this the provider is out of network. If the treatment costs would have been reasonable it would not have been such a problem, but the provider charges the ‘criminal’ amount of 9000 for each IV, which I only found out after receiving all treatments.
Yes, by “experimental” they mean it is not a “standard of care.” Conventional docs do not recognize a chronic form of Lyme and due to the IDSA’s restrictive treatment guidelines (saying Lyme can be cured with 2 to 4 weeks of oral doxy and is “hard to get, easy to diagnose and treat”). What this means is that insurance providers have carte blanche to reject any treatment other than what the IDSA and CDC have directed. That said, to charge $9000 for one rocephin IV is over the top expensive! Did your LLMD have you sign treatment consent forms, outlining your out-of-pocket costs if your insurance carrier didn’t cover the treatment? They should have provided you with advance notice of their charges for IVs. Also, given that this cost is extortionate, did you contact your insurance carrier in advance to check whether they would approve the IVs or not?
My suggestion to you would be to call Infuserve America at the following link. This is a Lyme Literate pharmacy and they can tell you how much they charge for one rocephin IV. I would then call the LLMD and tell them that you think there must be misprint on your invoice. Pretty sure Rocephin does not cost that much!! If $9000 is the total cost of the IV series, then that is more acceptable, but still very expensive for just 12 IVs.
I have done a last IGX report which (lucky me) now shows alse positive Lyme according to CDC. I hope the insurance will recognize this. Still I have a 20% of 9000K x 12 treaemnst hanging above my head for the out of network situation, which, again, is outragious. My insurance has not yet received, I believe, that last IGX report.
The positive CDC result may well help your case when you appeal, but I’m very doubtful that any insurance company would pay $118,000 for 12 IVs of anything (unless it was IVIG which is extremely expensive). Seriously, one could probably buy a small condo in FL for that price or a luxury car!!! There has to be something wrong with the invoice.
Advise how to deal with this situation is appreciated.
Honestly, if anyone charges $118,000 for 12 IVs an abx, then they need to be reported to the health board or better biz bureau. I feel certain this must be a mistake and, if not, then this must be appealed. I’m doubtful any insurance company would cover that cost.
Please do call Infuserve America to check the cost of IV Rocephin before you do so. Better to be forearmed before questioning this. This pharmacy serves LLMDs all over the country and their prices are extremely reasonable. They call the patient to confirm the order and to take the credit card, so there is no chance of price-gouging. I paid them directly for approx. $200 for 10 self-infusing elastomeric balls of 900mg clindamycin (including all the saline and heparin needed to flush the line) that I could do at home on my own and my doc only charged me $65 to insert the line in my arm.
Karel, can you PM me the name of this doc? Much appreciated and sorry you are having to go through this worry. I feel sure it has to be a mistake of some kind or something is very amiss!
Maz thanks for giving me so much feed back and support and for sure I will contact your advised infusion center for a reality check.
I wasn’t informed at all on the costs at any point in the (pre) treatment, but i might have signed a paper. My doc, an LLMD is probably ok, but the infusion center she works with, is probably not. They are separate parties, but for sure I am trying to get in contact with her as well on her thoughts. I will PM you the name of the doc and infusion center for your info.What is an IVIG? The IV contained I believe some vit C as well, but as far as I know that is the only active other component, although some more chemicals were specified, probably as support. Rocephine was charged at US$6000 and including the other components it came up to over US$9000 dollar per IV, as stated. Obviously, i didnt had any idea that costs could be so high, otherwise I would have contacted my insurance upfront. I believe however that the provider had to pre-certify, and I am not sure at this point what the result of that was, since I wasnt aware of the requirement, didn’t ask for the results, and didnt receive any feedback from the provider before or during treatment.
It is a bit of warning for everyone working on ABX treatment. Even if you find a trustworthy person willing to support you, keep an eye on costs and insurance situations.
By the way, funny that you mention Clindamycin. I had 6 IV’s of them. They charged US$ 3000 each, insurance paid much less though and also there I am still exposed. Texas probably still wild wild west.
Thanks so much!
@Karel wrote:
I wasn’t informed at all on the costs at any point in the (pre) treatment, but i might have signed a paper. My doc, an LLMD is probably ok, but the infusion center she works with, is probably not. They are separate parties, but for sure I am trying to get in contact with her as well on her thoughts. I will PM you the name of the doc and infusion center for your info.
Okay, this explains things a bit better. The Infusion Center is doing the price gouging. See if you can get a printout of anything you signed with infusion service and doc re: the IVs. This will provide a clue what you signed up for, but it may also provide some legal loopholes. Lyme patients suffer from extreme brain fog. I recall that in the beginning I was so brain-fogged, I couldn’t remember my age some days or what I was getting up to do by the time I got to the other side of the room. If this has been the case for you, then the doc should have ensured someone signed the paperwork who was a bit more compos mentis.
What is an IVIG?
IVIG = IV immunoglobulin. In order to be FDA approved, the immunoglobulin must be harvested from at least 1000 blood donors. Just think of the man-hours involved in doing that many blood draws, blood screenings, processing to isolate the immunoglobulins, etc. etc.
The IV contained I believe some vit C as well, but as far as I know that is the only active other component, although some more chemicals were specified, probably as support. Rocephine was charged at US$6000 and including the other components it came up to over US$9000 dollar per IV, as stated. Obviously, i didnt had any idea that costs could be so high, otherwise I would have contacted my insurance upfront.
Vit C for infusion costs pennies to a few dollars…it’s very inexpensive. You can check the cost with Infuserve, but it certainly wouldn’t be $3000, even if mixed with various other vitamins, minerals, etc.
I believe however that the provider had to pre-certify, and I am not sure at this point what the result of that was, since I wasnt aware of the requirement, didn’t ask for the results, and didnt receive any feedback from the provider before or during treatment.
If the infusion company didn’t check with your insurance company or, if they did, and didn’t notify you of the rejection of payment for this service, then the infusion company should have notified you and asked if you wanted to proceed.
It is a bit of warning for everyone working on ABX treatment. Even if you find a trustworthy person willing to support you, keep an eye on costs and insurance situations.
Absolutely agree. Perhaps your Lyme doc can help you sort this out if they were in no way involved with these charges. I’m sure she will want to know what has happened to you and may think otherwise when sending another sick patient to them.
By the way, funny that you mention Clindamycin. I had 6 IV’s of them. They charged US$ 3000 each, insurance paid much less though and also there I am still exposed. Texas probably still wild wild west.
You could have flown to Iowa for that price, stayed in a hotel for a week and seen Dr. S. for his 10 infusions of clindy for the 5 day series. Their pricing is beyond the pale and something is very wrong with this picture. I paid $20 per infusion of clindy through the infusion pharmacy in FL. My LLMD has a special Lyme doc deal with them, but nevertheless…this speaks to how much profit this place has to be making. Not good. 🙁
I remember now that I asked them if everything was settled with insurance and they said yes, left my insurance info with them a couple of days before. I had learned my lesson from the Clindamycin rip of. I also remember for sure that no mention was made of any issues with the insurance or any indication was given of the prices.
wow Karel how very sad for you–like anyone needs something like this on top of health issues. I hope you can do everything possible to get this appealed. It is criminal to be price gouging to such an extreme. I had Clindy IV –four a week for 16 weeks and the drug part was paid by insurance, I paid for the line to be put in and for the IV supplies. It was not expensive at all. I can’t recall exactly but I think around 120$ for four. Then I did a 5 day series once a month for 8 more months. I am in Canada so it’s a bit different. A friend of mine was on Rocephin and paying out of pocket so I don’t imagine the drug cost is hugely more than Clindy though I am just guessing. I hope you are at least feeling better for the IV’s . I found mine very helpful and they put my SD into remission. Good luck to you in sorting this out.
kate
I now do therapy IV instead of antibiotic–I get 3 bags run–Meyer’s cocktail, glutathione and Curcurmin. All three cost less than 200$ total for the doc to do. Not insured but worth it I think.Systemic Scleroderma since 2010. Lyme and Myco P. AP and many other antibiotics and treatments since Nov. 2011. Presently mostly in remission other than fatigue.
Teva Minocycline 100mg a day. Dessicated tyroid, LDN 4.5, LDI, hawthorne, curcurmin, berberine,, caprylex, reishi mushroom, liver protect, zinc,, fish oils, magnesium, vit K2, d3, bcomp, E, CThank you Kater. Glad the IV work for you and these prices are very acceptable, at least for me. I have only tried Meyer now, for four weeks and it does seem to work better than anything else I have taken (ABX IV and Oral), but it seems to require a weekly repeat.
It looks like I have some good news after a night of worrying and some calls this morning, but its too early to mention.
Thanks all for your input!Hi –You have to be nasty with them —Point # 1 –they should have gotten prior approval from your insurance co. before proceeding –EXCEPT if you signed a form saying you are responsible for all bills if insurance does not cover —Point #2 You do have a problem with this out of network thing
Point # 3 —-They charged an exhorbitant amount based on them being knocked down by the insurance co —-A great example —when I went to Boston for treatment -I wasnt covered for doctors visit but was covered for all labs —the doctors fee for a so-called cash patient was 150.00 and this was for one of the best and famous doctors using AP -if the insurance covered the bill would have been a minimum of twice that –Point #4 -You have to play hardball because these people have no conscience and will absolutely bury you !!!!!!!!!!!!- Heres a plan —-Step 1 –Tell your doctor the infusion center that she sent you to is charging a terrible amount of money –then tell her you will retain a lawyer and see what your rights are –Wait one week then tell the infusion center you will not pay this exhorbitant amount and will retain counsel as well as file a complaint with that states medical board –DO NOT PAY THEM ANYTHING until the price is reduced –just tell them you just dont have that much money -since you live in another state–collection on their part is very difficult if not impossible and they know it —They might make a lot of noise about judgements , bad credit ,etc –just be firm and say that you dont owe them this money since they failed to notify you that your insurance would not approve it —Instead of paying them so much money -its well spent to find a sharp lawyer in YOUR state —
richie
You must be logged in to reply to this topic.