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» LymeNet Flash » Questions and Discussion » Seeking a Doctor » Why Lyme Doctors Don't Take Insurance

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Author Topic: Why Lyme Doctors Don't Take Insurance
TF
Frequent Contributor (5K+ posts)
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Why lyme doctors don't take insurance

Lyme doctors generally don't take insurance because they would lose money if they did. Insurance companies reimburse doctors based on the amount of time they expect an appointment to take. If you notice, when you see a regular doctor, he generally spends about 10 minutes with you, or 15 max. That is because that is all the time he can spend with you and not lose money.

Doctors have done the math. They know what it costs them to pay the rent, staff, malpractice insurance, etc. So, they know how much money they need to make each day. And, they know how much insurance will pay them for a routine office visit.

They have calculated how many patients they must see every day to break even and how many they must see to make a profit. So, the insurance reimbursement is determining how much time a doctor can spend with each patient.

Doctors who accept Medicare lose money on each Medicare patient they see. Medicare reimburses a doctor less than regular health insurance. So the doctor is reimbursed less than what it actually costs the doctor to see a Medicare patient.

Because of this, many have to limit the number of Medicare patients they accept. They make up for what they lose on a Medicare patient by taking additional non-Medicare patients.

The day may come when many doctors will have to stop accepting Medicare patients for this very reason. For this reason, lyme doctors also cannot accept Medicare patients. They would lose too much money on each one if they did. They would have to go out of business if they did.

One doctor (not a lyme doctor) has made a rule that he will not take any new patient who takes more than 3 medications. By having this rule, he gets only new patients who have very few medical problems. These are the easy patients who take less time at each appointment. This is the rule he has to have in order to not lose money practicing medicine.

My husband's former internist (not a lyme doctor) likes to practice medicine the old fashioned way. He likes to spend time with the patient. He likes to educate the patient about their health issues. He generally spends 1/2 hour with each patient who comes in for a routine visit. He never rushes you in and out.

Because of this, he can't take insurance. Instead, he charges you what he needs to charge for a 1/2 hour appointment. Then, he submits a claim to your insurance for you and the insurance company then reimburses you the amount that they have determined that that office visit is worth. The insurance reimbursement is always less that what the patient pays the doctor.

So, based on their reimbursement schedules, the insurance companies are determining how much time doctors can spend with each patient and still stay in business.

The problem with lyme is that a doctor must spend much more time with a lyme patient than he does say with somebody who has come in with the flu or a cold. But, insurance companies don't allow any more time for a lyme patient than they do for any other illness.

Most lyme doctors spend at least 1 hour with the patient at the first appointment. That's how long it takes because lyme is difficult to diagnose. It is generally diagnosed based on symptoms and medical history and elimination of other possible causes of the patient's complaints.

Insurance companies will not reimburse a doctor for 1 hour with a patient. So, that forces the lyme doctor to not take insurance so that he can give good care to his patients.

In the 1990s I heard a doctor (not a lyme doctor) say on the radio that he had to see twice as many patients in a day to make the same amount of money he used to make. So, that means he had to cut in half the amount of time he spends with each patient. If he used to spend 1/2 hour with each patient, on average, then he had to cut that time to 15 minutes.

It was then that I noticed that all doctors (not talking about lyme doctors) were shortening the amount of time they spent with their patients to about 10 to 15 minutes. This is why.

Besides the time factor, if a lyme doctor took insurance, the insurance company would often dictate to him how he could treat the patient.

When I first started treating lyme, I went to a doctor who took insurance. He said to me at the first appointment, "I'd put you on IV but your insurance company would give me a fit."

At the time, I didn't understand what he meant. But I do now. Generally, insurance companies severely limit the amount of time they will pay for a patient to be on IV (intravenous) medication. For example, they generally only allow 30 days of IV meds. However, for a lyme patient, 30 days is nothing.

If a lyme patient needs IV medications, it is often necessary for them to stay on IV for 6 or 9 months or even more. The length of time is determined by how the patient responds to the treatment. But, insurance companies treat lyme the same as all other diseases. They don't allow for lengthy IV treatment.

So, in my case, rather than fight with the insurance company over my treatment, the lyme doctor gave me oral medications. He didn't give me the treatment he believed I needed because of insurance company policies.

So, as you can see, if the lyme doctor takes insurance, the insurance company reimbursement policies are dictating the lyme treatment that a patient will get.

Faced with this, a good lyme doctor usually decides to not take insurance. He decides to treat the patient with the best treatment available and let the patient then deal with his insurance company. This way, the patient can get the best possible treatment.

This method leaves it up to the patient to fight with the insurance company if the insurance does not want to pay for the treatment the doctor is giving.

The lyme doctor who finally cured me did NOT take health insurance.

Some insurance companies also refuse to pay for certain oral medications (generally the expensive ones that lyme patients often need) or refuse to pay for the high dosages that a lyme patient needs.

So, the insurance company gets very involved in lyme treatment and may deny payment for the oral medications a lyme patient needs.

I even met one doctor (not a lyme doctor) who told me that he quit practicing medicine because the insurance companies were dictating how he treated his patients. He couldn't live with that, so he switched to teaching instead.

More and more, I have noticed that the best doctors (not talking lyme doctors) do not take insurance. My husband and I have a number of doctors who don't take insurance. Often these doctors are specialists, but not always.

So, more and more doctors are seeing that they can no longer take health insurance and still provide good care for their patients and make a reasonable living for themselves.

Posts: 9931 | From Maryland | Registered: Dec 2007  |  IP: Logged | Report this post to a Moderator
Lymetoo
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Thanks so much for going to the trouble to write this again! I have added it back to the link in Seeking titled "MORE WAYS TO FIND A DOCTOR and WHY you need an LLMD."

--------------------
 -
oops!
--Lymetutu--
Opinions, not medical advice!

Posts: 93756 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
Keebler
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-
IDSA . . . ILADS . . . how are they so very different and why that matters so very much?

http://lymedisease.org/news/lymepolicywonk/lymepolicywonk-two-standards-of-care-revisited.html

Two Standards of Care Revisited: Should Lyme Patients Have A Choice?

- by Lorraine Johnson - January 2015
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Posts: 47815 | From Tranquil Tree House in my dreams | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
Ann-Ohio
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Please do not be totally discouraged.

Some doctors DO take insurance and treat Lyme disease.
Please call and ask the staff if the doctor takes your insurance.

Ann

--------------------
Ann-OH

Posts: 640 | From Ohio | Registered: Aug 2014  |  IP: Logged | Report this post to a Moderator
Keebler
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-
When seeking lyme literate MD or ND (naturopathic) doctors

[regarding naturopathic care: in some states, certain aspects of care / symptom relief may be covered by some insurance plans, too]:

Good to contact ALL the lyme support groups within a wide radius to you (or to any LLMD or LL ND you consider).

That way, you can get a broad range of input from various members / leaders, starting first with the insurance questions:

1. any doctor TAKE insurance? (yet realize that this can be spotty - or piecemeal - so get detail on how much others might have had covered);

2. any lyme FRIENDLY doctors? (They may not be able to treat lyme / TBD outright but may help in various ways)

Even if you get detail from a group member or leader, always call that particular doctor's office then to be certain information you received is both accurate and up to date.

3. regarding your particular insurance plan, experiences of members as to doctors / Rx coverage

4. any suggestions from members about not raising any red flags with insurance - or at the pharmacy?

For instance, you do not want to "declare" or even mention to your insurance company or to any pharmacist ANY diagnosis. There are some navigation tools beyond that, too, that others can share.

Then move on to other questions of a particular LL doctor's treatment practices, successes, etc.
-

Posts: 47815 | From Tranquil Tree House in my dreams | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
cheryljoy
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It is a sad state of affairs that so many doctors that are Lyme Literate will not take insurance.

If you are not rich, you don't get to have appropriate treatment for Lyme.

I didn't get treatment for a long time because I couldn't afford to go to the others, until I finally found my Dr. who takes insurance.

That is probably why my symptoms got so bad, because I couldn't afford treatment and couldn't find a Lyme Literate doctor that takes insurance at the beginning.

I think because of delayed treatment, most likely some of my symptoms will not ever totally go away.

I understand there are numerous reasons for doctors to not take insurance but because of that, only people with extra thousands of dollars can afford to get treatment.

It's extremely expensive - when I called, Dr. M was $900.00 for the first visit, $600 for subsequent visits.

Dr. C. was not much different.

It was at least a year and a half later that I finally found my doctor, a LLMD who takes insurance.

Posts: 9 | From Valley Forge, PA and Syracuse, NY | Registered: Jul 2014  |  IP: Logged | Report this post to a Moderator
Robin123
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My personal opinion is, if you have any insurance, ask if there are any Lyme-treating doctors in areas you would go to who accept insurance before paying the big bucks to most of those who don't accept insurance.
Posts: 12738 | From San Francisco | Registered: May 2006  |  IP: Logged | Report this post to a Moderator
Jordaine
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Thank you for the info. I don't agree with the writer who says most LLMDs don't take Medicare. Most retired people who have been ill for some time subscribe to Plan F - where Medicare is the primary insurance but you also have supplemental insurance. We pay $$ for this, but it's worth it, because doctors are assured they'll get paid.

If I find a LLMD in AL, I'll add to the post.

--------------------
Jordaine

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NanceLynn
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TF,
Thank you for writing this informative explanation!

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AngieGigi
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How do you find a LLMD that take insurance? I am having a hard time finding a LLMD at all.

I am looking for OH/IN/KY/PA we are willing to drive.

My dear friend only has Medicaid because she can not work because of being so sick.

Any help would be appreciated

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TF
Frequent Contributor (5K+ posts)
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I doubt you will find any lyme specialist that will take her Medicaid.
Posts: 9931 | From Maryland | Registered: Dec 2007  |  IP: Logged | Report this post to a Moderator
hopingandpraying
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Here are some resources for you to look into for financial help:

"Financial Help and Other Information"
http://flash.lymenet.org/scripts/ultimatebb.cgi?ubb=get_topic;f=3;t=023463;p=0

Call the Lyme Disease United Coalition at (800) 311-7518. They are very knowledgeable and might know of a LLMD who takes Medicaid.

Also look on their website:

http://www.lduc.org/lyme-disease-resources

Scroll down for financial help available from various sources.

"Help for You" link:
https://sites.google.com/site/marylandlyme/help-for-you

For anyone who qualifies as low income, www.lymetap.com will cover 75% of IGeneX test costs.

Posts: 8529 | From Illinois | Registered: May 2006  |  IP: Logged | Report this post to a Moderator
   

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