Questions about insurance coverage–BC/BS

[m.]

Someone I know from another message board is having trouble with Doxy. She went to fill a prescription for Minocin (not generic) and was blown away by a $500 price tag.

So, first question, does it need to be brand name, and are there other less expensive sources for it besides Walgreen's?

Next, has anyone with Blue Cross Blue Shield had luck getting IV treatments covered in Ida Grove? And, has anyone had luck getting IV treatments covered in home?

Thanks in advance!

[nspiker]

Hi M,

I also have BC/BS and had the same price tag for name brand minocin.  You can order minocin from Canada (http://www.buylowdrugs.com), and the price is around $165 for 100.  I have taken minocycline generic, but the Teva and Watson brands are recommended.  You can ask the pharmacy to order these specific generic brands to fill your prescription.

I had no problem getting IV treatments with BC/BS.  My AP doc prescribes the treatment, and a home health nurse, from a reputable hospital, comes daily to infuse. 

nancy

[Fran]

M-  So far, I've not had any issue with BC/BS.  When I went to Ida Grove two years ago, they covered my IV treatment with Dr. S.  2 weeks ago, I had IV treatment at home through Dr. S with a home health infusion center.  We received preauthorization and so far, BC/BS is covering it. 

I was careful though.  I let Dr. S code it properly the first time and the second time when I spoke with the home health infusion center and the insurance company, I was sure not to mention RA and only mentioned mycoplasma infection as the reason for the IV treatment.  I really needed coverage and did not want it disputed.  I did test positive for m. hominis so I wasn't being deceptive, just not discussing the RA portion.  Good luck!

[Cheryl F]

Dr. S knows how to submit so insurance will cover the IVs.  And Fran is right, don't mention that it is for RA, it is for Mycoplasma infection, the fact that the mycoplasma infection may be giving you RA symptoms is not pertainent to the insurance company. 

Good luck!

Cheryl

[m.]

Wow! Thank you SO much for the helpful tips and advice. Excellent! I'll pass the word on.

[mschmidt]

I don't have BCBS–I have Humana but, no problems getting them to cover my iv's or medications.  I was able to get the brand name Minocin covered by my insurance company–if YOU request the brand name and not your doctor, the pharmacist runs it through differently, and it's not covered.  If your doctor puts “DNS” (do not substitute) on the Rx order, insurance usually won't dispute that.  (I talked extensively to a couple of pharmacists about this)  I have Scleroderma, and told my IM doctor that the powderized version of Minocycline burned my throat and irritated my GERD.  The brand name is pellitized, and easier on the esophagus so, he wrote the prescription DNS.  I have a higher co-pay with it ($55) but, it's better than the $600+ I was quoted when I aked the pharmacist what brand name vs. generic would cost. 

Maria

[PhilC]

[user=732]m.[/user] wrote:

Someone I know from another message board is having trouble with Doxy.

What kind of trouble? The reason I ask is because there may be a way to get around the problem without switching antibiotics.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[mystic1949]

Hi

  Actually, I am the person who's having trouble.  First, the extreme dizziness which has not gone away in the 8 months I have been taking doxy and is sometimes intolerable.  Second, the acid reflux, which is new for me….it happens only when on doxy and even several hours after I take it with food.  Third…I get systemic candida while on it, and never had candida before.  Despite the fact I do not eat sugar or white foods, and am now taking a probiotic daily.

I would prefer Minocin and here's why: I took Minocin about 16 years ago for RA…I got rid of my RA in approx one year on the 100mg Minocin daily.  RA factor gone, sed rate, returned to normal, rheumatoid nodules, gone…..before I began the protocol, I thought I was looking at knee replacement surgery but this got rid of every last bit of pain and joint limitation. I went 15 years without any joint pain or flare-up, and it snuck back so slowly I didn't realize it until I was in full blown pain and inflammation again. I was tested for mycoplasma last June and tested pos. Of course, Minocin might not actually be my answer either, at this point.

My story is more complicated than this….although my RA was gone in 1994 and I felt a lot better, my CFS remained.  I underwent the Stratton Protocol for  Cpn from 1998-2004 and got rid of that.  Had 5 years of complete health and wonderful energy in my 50's – better than ever before in my life.  A couple of years ago, my fatigue and joint pain began to creep back slowly…I believe this is only the RA..I tested neg two years ago for Cpn and am about to retest for that, but my titers are now in the very lowest of normal range.

Diana

[Joe M]

Hi,
Our BC/BS covered the Ida Grove treatments.  As others have stated, Dr. S codes it as treatment for infection.  What insurance companies don't know won't hurt them. Good luck!
Joe

[Kim]

My Aetna insurance covered the IVs in Ida Grove.

kim

[mystic1949]

Thanks, Joe.  I have only just begun looking at the clindamycin IV's ~  I am sure my doctor will know how to code this. But most likely we will do it here, in Chicagoland.  Can anyone tell me how many or how often these IV's are done?  Or is it an individual thing?  I am hoping Dr. S will agree to consult with my doc about this.

With my last treatement of my RA with Minocin so many years ago, I also took 50mgs DHEA and GLA from borage oil.  The rest of the vitamins and supps continue to be the same ones I have taken all my adult life, most of them in mega doses.

Diana

[mystic1949]

Thank you Maria. The pain and acid reflux I have when I take doxy is horrid and it lasts all day and night, even if I take the doxy with food.!  so, what you have said makes sense to me. 

Diana

[Joe M]

[user=2090]mystic1949[/user] wrote:

Thanks, Joe.  I have only just begun looking at the clindamycin IV's ~  I am sure my doctor will know how to code this. But most likely we will do it here, in Chicagoland.  Can anyone tell me how many or how often these IV's are done?  Or is it an individual thing?  I am hoping Dr. S will agree to consult with my doc about this.

Hi, I'm not too sure, but I think they do one or two a day for five-seven days.  Don't know dosages or anything like that.

Others who have had this done recently will hopefully clarify…

[nspiker]

Hi Diana,

I see Dr. F. in CA, and he prescribed clindamycin IV's for seven days, at 1200 mg. day (all at once), three weeks off, one week on.  I begged, and now he moved it up to a week of IV's every three weeks.  There are varying degrees of the protocol; some for five days and some infuse twice daily.  Some programs ramp up from 300, 600, 900 and then 1200 mg day.  It really depends on your doctor, and how you respond.  I never had any herxing or negative reaction from the IV clindy, some do.

Sounds like you have been down the treatment path with Cpn and AP for years, with great success.  Are you saying that you also have CFS?   I have had CFS for years, and prior to these newly developed ReA symptoms, was doing really well.  During this process to uncover the cause of my ReA, I was clinically diagnosed with lyme, and am currently being treated for babesia, a co-infection of lyme.  Have you been tested for lyme through Igenex?  I am now wondering if my CFS symptoms from years ago, could have been triggered by lyme and/or babesia.

Good luck with IV Clindy.  My insurance is also through BC/BS of Illinois, so I know it should be no problem for you to get approved, especially with a mycoplasma infection.

nancy

[Kim]

The IVs that I had in Iowa were all Clindamycin 900 mgs, 2 per day, 5 days, for a total of 10 IVs.  It does seem to vary with different doctors.

kim

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