posted
I was bitten by a tick in August 2010. My wife removed the tick and shortly afterwards I had a large red rash in the same area. I have experienced many symptoms indicative of lyme disease (LD). I have been tested 3 times all producing negative/normal lab results.
I have been calling around searching for a lyme-literate medical doctor (LLMD) in my region (Virginia). Nearly all I have contacted do not accept insurance and require a cash payment at the time of the visit. Is this a common/legitimate practice [amongst lyme doctors]? If so, what is the reason for this? And, how do most lyme patients pay for visitations with their lyme docs?
I appreciate any and all feedback on this matter; as I am trying to get the appropriate help for my condition. Thank you.
Posts: 12 | From Richmond, VA | Registered: Feb 2011
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I think it is because they take a long time in the visit and can't get the insurance to reimburse at a reasonable rate for the time spent.
Also, insurance would restrict what treatment they could provide.
The ones I have seen seem to charge a pretty high rate, until you compare them with what a regular doctor gets per hour. For example, our pediatrician gets $85 per visit from me and the insurance. If she sees 6 patients in the hour, she gets $510 per hour.
So to me, to pay $500 or more for an hour visit seems more than reasonable. It is just that I am paying the whole thing and it isn't being divided between patients and insurance.
Early on, I took my daughter to an infectious disease doctor who charged around $515 for the few minutes she spent there. Recently, I took her to a cardiologist who sent in his PA and didn't even see her himself, and he charged $900. That visit might have been 15 minutes. Both of those visits were covered by insurance, though.
The LLMD's I have seen take credit cards. I pay them and then submit for insurance reimbursement and get back 70% of what the insurance company thinks is reasonable.
Posts: 984 | From US | Registered: Dec 2007
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
Yes, it is typical that a lyme doctor does not accept insurance. The cost of the first visit is often extremely high.
You pay for the visits and the Igenex blood tests at the time of the visit. You can put the charges on a credit card. That's what everyone does.
You can then submit a claim to your insurance company and see how much they reimburse you. Generally, it is not much.
Why the lyme doctors do this is most likely because they have to in order to make any money. I never was in business as a doctor, but it makes sense that they can't make any money, and in fact will lose money, if they take insurance and treat lyme patients.
You see, the first visit with a lyme patient often takes 1 hour to 1 1/2 hours of the doctor's time. Yet, insurance will reimburse him very little for this.
Lyme is complex to diagnose and treat, but the insurance companies don't treat a lyme patient as needing any more time than the patient that comes in with the flu.
That's why insurance taking doctors can only spend 10 minutes with each patient. Did you ever notice that that is, on average, how much time they give you? If they want to make money and not lose money, that is what it comes down to.
Medicare reimbursement is even lower than regular insurance reimbursement, so many doctors are no longer taking Medicare patients. They have to in self defense. This is eventually going to become a crisis in this country. Many doctors (not lyme doctors) limit the number of Medicare patients they will accept into their practice since they lose money on every one they take.
The first visit with a lyme doctor will probably have you in the office for about 3 hours. That includes the interview with the doctor and the doctor's staff's time--the blood draw for Igenex, and the paperwork before the interview.
The doctor has to factor the cost of his staff's time into the charge for your first visit and all other visits.
Another consideration from the doctor's point of view is likely the insurance company oversight of his treatment.
My second lyme doctor took insurance. He said to me at my first appointment, "I'd put you on IV but the insurance company would give me a fit." Therefore, he put me on oral medications. I didn't understand what he was talking about at the time. But, now, looking back, I do.
So, that tells you that if the doctor takes insurance, he is not free to treat the lyme patient the way he wants to treat. If he doesn't take insurance, then he can treat the patient in the best way he knows and not worry about whether or not the insurance company agrees to pay for it.
In general, insurance companies will fight the lyme doctor if he tries to put the patient on IV for more than 30 days. The patient who needs IV needs it for much longer than 30 days. 30 days does nothing.
Also, some insurance companies fight the doctors on the high doses of antibiotics that the lyme patient needs, and the combos of antibiotics that the lyme patients need. The lyme doctor can raise red flags in the insurance company office for these meds and can get hauled up on charges with his state medical board and ultimately lose his license to practice medicine.
That has happened to many lyme doctors. So, the best way for them to operate is to make you the person who deals with the insurance and pays what the insurance refuses to pay. Now, that way, you can get good lyme treatment.
In my experience, my first two lyme doctors took insurance and they could not get me well. I spent 2 years, which I now consider wasted, with these doctors. Then, I switched to a lyme doc who did not take insurance and got cured in one year.
In general, not even talking lyme doctors now, the best doctors don't take insurance. We have learned this in my family. So, my husband's internist does not take insurance, neither does his psychiatrist (hardly any of them take insurance), and neither does my endocrinologist.
I heard a doctor say on the radio about 10-15 years ago that he now had to see twice as many patients as he used to in order to make the same money. That is how insurance controls the health care in this country.
Not talking lyme doctors now--when you go to a non-insurance taking doctor, he generally will spend at least 1/2 hour with you if not more at each visit. He can talk leisurely with you, listen to you without interrupting, and teach you things because he doesn't have to watch the clock so that he doesn't lose money on you.
My husband's internist (doesn't treat lyme) told us that his brother (also a doctor) has a rule in his practice that if the patient takes more than 3 medications, he cannot be his patient.
That is how he limits his practice to the easy to treat patients who will not take much of his time. All this is to keep the doctor from losing money. They lose money if they spend more than 10 minutes with you. They have done the math, figuring all of their overhead and staff salaries, and that is what it comes down to every time.
My husband's doctor (doesn't take insurance, doesn't treat lyme) told us that he is losing money treating the old fashioned way--spending time with the patient, as much as the patient needs, and educating the patient. So,he has to try a new business model to make a decent living. He refuses to give up practicing medicine the way he believes is right.
He is moving to a membership only practice. To see him, you pay a high membership fee up front at the beginning of the year.
So, just know that there is a major upheaval going on in the world of doctors in private practice. They are really scrambling to make a living, having to run faster and faster on the treadmill set up by insurance company reimbursement schedules, just to make a decent living. That is why many Americans are no longer going into medicine and many, many people from foreign countries are filling the doctor vacancies in the U.S.
About 10 years ago I talked with a man who quit his medical practice due to insurance companies dictating to him how he would treat patients. So, this is being told to me by many, many doctors over at least the last 10 years.
So, get to a good lyme doctor and pay for his expertise. Don't let insurance concerns get in the way of you getting your health back. These doctors are legit. No rip off. Good for you for wanting to understand what is going on.
Posts: 9931 | From Maryland | Registered: Dec 2007
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lou4656
Frequent Contributor (1K+ posts)
Member # 10300
posted
Here is a post from Tracy in 2008:
"Why LLMD's would not accept insurance, nor be a prefered medical provider for any insurer.
#1. The Dr's must sign a contract with the insurer that says they will "Treat within the Standard of Care", and are basically under the watch of the insurance company.
If not they can be immediately removed from the panel and subjet to PEER/other Dr review.
2. This opens their charts/records to routine audits by insurance companies & other Dr's that work for the insurance company.
3. This subjects ALL the physicians billings to review.
4. Most complaints to State Medical Boards- DO come from insurance companies-- as they see all the claims, and costs. Especially those that vary from the norm.
i.e. Going to 15-20 doctors on a Dx hunt is fine, but get Dx with Lyme and your benefits can be limited.
5. Reimbursement for a standard office visit follow-up comtemplates appx 5-7 minutes of time. Most LLMD take 5-10 times longer per visit.
6. Insurance companies push a lot of extra paper work on physicians to justify Dx and treatment-- especially for any type of chronic care.
Last- the insurance company will only pay what they pay for reasonable and customary care- which is about $90-170 per visit."
Basically, LLMDs treat outside of the recommended guidelines, which makes them a target from medical review boards. And, LLMDs spend from 1-2 hours with their patients for the first appointment, and will get paid by the insurance companies $100-200 per visit.
Most lyme patients do whatever they can to pay for doctor visits. I put thousands on credit cards that I am still paying on two years later. Some people have even sold their homes to pay for treatment. But for me it was worth every penny, because I am healthy today.
I am sending you a private message.
-------------------- LouLou Posts: 1276 | From maryland | Registered: Oct 2006
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posted
Thanks everyone for your helpful information and advice. I will pursue proper Lyme treatment through an LLMD. Thanks again.
Posts: 12 | From Richmond, VA | Registered: Feb 2011
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posted
Hey moderators, TF's post made this issue clear to me in a way no one else has yet. It's worth saving.
The UOS documentary and posting rules here gives a very secretive feel to getting treated, which seems weird when some docs post on their websites that they treat lyme. I couldn't get this to gel in my head and TF made it clear. Thank you!
-------------------- ------------ It took 20 years to find out I'm not crazy. New bite in 2010 pushed my body over the edge. Positive for lyme, babs, bart, and myco. I am not a doctor and happily offer only my own opinions. Posts: 357 | From The Beach | Registered: Feb 2011
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quote:Originally posted by sbh93: Hey moderators, TF's post made this issue clear to me in a way no one else has yet. It's worth saving.
The UOS documentary and posting rules here gives a very secretive feel to getting treated, which seems weird when some docs post on their websites that they treat lyme. I couldn't get this to gel in my head and TF made it clear. Thank you! [/qb]
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I beat you to it!! I saved the thread under the doctor stickie here in Seeking. I just hope newbies will read the stickies!! Lots of good info there!
posted
Well, I have another take on it, which is people without the money to see a Lyme doctor can't see a doctor, and they are suffering.
So many are debilitated, so many have lost their work, some are not married with working spouses, some do not have family, some are young, so many suffering poor who do not have the hundreds of dollars to pay for care.
I wish a foundation could be created that people with means could choose to contribute to, and people could also choose to tithe, like for example, 5% of what they spend on their own monthly care, so that others could have a chance to treat.
Posts: 13116 | From San Francisco | Registered: May 2006
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posted
Insurance has gotten completely out of control in the USA, which is why it's so expensive. When my car requires an oil change or new tires, I don't expect an insurance company to cover that. My car insurance is intended to cover major accidents - not routine maintenance. Likewise, health insurance should not cover routine office visits, birth control, checkups, or other routine care. Health insurance should only cover major medical care - accidents, major illnesses (including Lyme), etc - unless, of course, the customer is willing to pay a MUCH HIGHER PREMIUM to cover routine care.
The bottom line is that we are paying the price for the inefficient socialization of our healthcare. Regardless of your politics, as Obamacare or other socialized medicine schemes come into effect, we will see the quality of our healthcare decrease and the cost increase. That will only drive many more quality doctors to take CASH only! We'll soon see a two tiered healthcare system: the government system of inferior care for the masses and the private system of quality care for those that can pay cash.
The Lyme Doctor that I'm seeing only takes CASH (no checks or credit cards). That's one thing that I like about my Lyme doctor. I appreciate the fact that she only takes cash because it keeps her costs and mine low. In fact, that is all that I take in my business also - CASH!!! I'm not chasing the never-ending line of deadbeats who write bad checks, nor jumping through all the hoops and expense to take credit cards. That keeps my costs low and the cost of my product low for my customers.
As mentioned above, another benefit of a doctor that only takes cash is that the CUSTOMER can pay for as much time as they want or need. My initial visit was a full 2 hours with my doctor and my next one is scheduled for 1 1/2 hours. We can go over every aspect of my care and cover my every concern in that length of time. I've never gotten that kind of care from a doctor that accepts insurance!!!
Posts: 177 | From Ohio | Registered: Aug 2012
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posted
There are now two funds that will help fund children's needs - LymeAid 4 Kids and the Lymelight Foundation (ages 3 - 25).
There are none for age 26 and up. There are too many adults sick and dying for lack of ability to access treatment. Many are on their own.
A tick bite, a bug bite, or other transmission, and bingo, there you are, struggling for your life.
I think we should start collectively thinking about how to structure a fund that those with some means who would like to help can donate to.
Posts: 13116 | From San Francisco | Registered: May 2006
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posted
I would like to reiterate - to please put on our thinking caps about how to possibly help adults with Lyme who have no funds. Just any ideas at all could spark more ideas. Maybe we could get creative about it.
A group of us have started to have this conversation.
Obviously, it's not an easy topic, due to it being like having to be like the insurance companies that would normally be covering!
Posts: 13116 | From San Francisco | Registered: May 2006
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