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» LymeNet Flash » Questions and Discussion » Medical Questions » Health insurance, chronic lyme, wellness incentive/health coach call

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Author Topic: Health insurance, chronic lyme, wellness incentive/health coach call
purplemom
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Unfortunately our insurance is changing come January. I am currently being treated for lyme with long term antibiotics (not IV--only oral) and my current insurance has covered MD visits and medications without question.

The new insurance, Cigna, has a plan called "Health Plus" where I can get $600 back for talking with a health coach twice. I am convinced that they only use this to save themselves money in the long run by denying claims or not approving meds. Since the insurance industry believes that lyme is cured in 2 to 3 weeks I am concerned about this.

My husband and I disagree on this and he believes they can not use the health coach info against you or that I can just not tell them everything. Apprently the 2 calls are months apart so if I don't acknowledge meds at the begining then they will surely now the 2nd call around.

Do you have Cigna and lyme treatment?
Do you know anything about health coaches and what they ask and how they use the info?
Will it be cheaper for me in the long run to skip the $600 incentive or can they deny the meds anyway?

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purplemom
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If you do not feel comfortable posting your experience with insurance here please PM me.
Posts: 207 | From NH | Registered: Jul 2009  |  IP: Logged | Report this post to a Moderator
sk8ter
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Do not do this..This is what they are starting to ration healthcare. i received one too and refused the offer. I called to find what is was about and they said so we can help you make decisions. I said that is why I have a doctor !!!! Giving them any info can help them build a case against you. My hubby is an attorney and he said no way!!!
Hope this helps

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Haley
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I agree. I keep getting this request. I have always felt uncomfortable with it. I never reply.
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WIZARD
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Just say NO.
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Keebler
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If they are willing to "give" a client $600, they intend to save MUCH more by denying you benefits that you pay for with your premiums.

Do NOT do this. I had a similar "coach" with my last insurance and it did result in my being denied good care. The information they gathered from "friendly" chats was turned against me, especially since it was hard to hide my emotions during some conversations.

A crack of the voice, fatigue, etc. can all me misinterpreted. And, if you have any flair of energy during any part of the conversation, that can also be used against you.

These "coaches" or whatever they call them are paid to find ways to save the company money. Why else would they do this? There may also be some fine print to your cashing that check . . . it could stipulate that you will follow the advice of your "coach."

It it tempting, for sure. But no one just gives you $600. for saying "hello" to someone who has the power over your very life by their determinations. Also, it's important to know that anything you say can land in your medical file, forever. How they interpret what you say can land in your file as a matter of fact.

Privacy is intended to be circumvented by seemingly very caring and carefully coached "coaches." The "coach" I had would catch me off guard, calling at her option, not when I would have prepared myself. I was more candid because of this - & it was harder to hide fatigue or depression being caught off guard. Mistake.

I had not been assessed for lyme at that time but the health "coach" was more than willing to go right along with the doctors who could find nothing.

I had to drop the Cobra plan, anyway when I just kept getting worse.

If you talk to a "coach" the diagnoses will not be able to go hidden. With lyme, some treatment can be covered without lyme actually being the diagnosis. But, when you establish a relationship with a "coach" who will be asking questions that you will need to answer, it's impossible to fly under the radar.
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Keebler
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http://www.managedcaremag.com/archives/0609/0609.employer.html

Managed Care Magazine - September 2006

Modest Investment in 'Coaching' Seems To Lead To Lowered Costs

. . . one-on-one dialogue coaching is essential to moving plan members from the conventions of managed care to the new world of member risk. . . .

. . . Employers and health plans must influence their workers and members to be more responsible for their health status and health care decision-making, and one-on-one coaching is seen as a top method for doing so. . . .

. . . "We've seen exponential growth, and I don't think it's going to slow down soon," he says. "Once people have been assessed regarding what their health risk and concerns are, they need tools and resources to implement change." . . .

. . . Clinical management. Coaches help members coordinate care among various providers, seek information to make decisions, and manage chronic or complex conditions. . . .

**. . . WellPoint health coaches, meanwhile, provide disease management services along with many others. . . .**
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Lymetoo
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Keebler... I see nothing negative in anything you just posted (above). My husband and I have both spoken to these nurses with our insurance co.

I've never mentioned Lyme. We have talked about A-fib and asthma. My husband has asthma too and I think that is mainly what is discussed with him.

Don't you think they already have access to whatever meds we're taking?

We get NO MONEY for doing this.

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

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Keebler
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Now, here's something you might propose: Tell them that you and your doctors are all set with your plan of action.

Ask them if you can get a discount for being smoke-free and adhering to a good diet? If overweight, they won't understand that lyme can cause weight gain, though, so you may not want to open that conversation.

But, if your weight is in the right ball park, you might be able to get points for that.

I will say that some of the "coaches" are interested in getting clients to lead more healthful life styles. If you show that you do that part, ask them for a discount.

Of course, as aerobic exercise is not allowed until well into remission, if asked, you can say that you follow the low-impact exercise plan from your doctor.

A Tai Chi class or similar activity might also serve as proof of your healthful life style.

It's worth a try as long as you can keep quiet about all diagnoses, treatments or disabilities. Keep saying, "my doctor and I have that covered" - and just keep using that as the answer for any try at invasive questioning.
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Keebler
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Now, we both know they are more intent in keeping clients from going to doctors than in changing habits but if you assume their sweet offer of a coach is primarily to help you pass by McDonald's . . . then this may just have a chance.

Some of this may be invasive - and it may set a bad precedent but if they are giving away bonuses for lifestyle, it may be worth a try. You'd have to ask them first and consider just how much you'd be willing to reveal. Or not.

Sample Draft:
-------------

Dear ______ (get the precise person's name):

Regarding your offer of a "health coach" - my doctor and I have worked out all the details of my care. However, as I understand it, the $600. client bonus is to help clients maintain a healthful life style. I would like to be considered for the bonus, while saving your company the time of a "health coach" since I'm already set up with a good plan.

If you are awarding those who improve their life style, it seems only fair to reward those who have been following such for some time already. I request the same degree of bonus as any other client who makes changes - I've just already made them and they have become my life style, such as:

* Smoke-free (if you have never smoked, that should be rephrased. "Neither tobacco nor any other substance" may be added.)

* I am not around second-hand smoke (Similarly, if "never" is appropriate, add that).

* Processed-foods free. Free of all additives and food dyes. Avoid sodas and diet sodas.

* Free of simple sugar/ simple carbohydrates

* Free of processed and fast foods - totally

* Maintain low-impact exercise protocol as per my doctor's suggestions

* Do consume the proper amount of lean protein, essential fatty acids and whole foods in fresh vegetables, fruits and whole grains. Water and teas are beverages of choice.

* Do not consume alcohol, although may do so but only in modest amounts if I choose to do so sometime in the future. I've never had a problem with alcohol, it's just that the sugar is too simple for my taste.

* etc.
-

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Keebler
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This article had caught my eye earlier, giving me the idea for the above health declaration. If I were an insurance company, it would be of benefit (to everyone) to steer clients away from fast food.
------------------------

http://www.cbsnews.com/8301-504763_162-20019427-10391704.html?tag=exclsv

October 12, 2010 - CBS News

Happy Meal Doesn't Decompose After 6 Months

Excerpts:

. . . Davies' experiment with the Happy Meal is the latest in a series of high-profile examinations of fast food. Morgan Spurlock, in the DVD extras section of his 2004 documentary "Super Size Me," performed a similar experiment with McDonald's food as Davies did. . . .

. . . In a January 2010 interview with Oprah Winfrey, food writer Michael Pollan said one of his rules on food is, "Eat only foods that will eventually rot." . . .
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Lymetoo
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What's strange is that the nurse has encouraged us to see our drs and have a plan of action, say for asthma.

I've told her about my shortness of breath, for example, and she tells me to be sure to make an appointment.

I've been trying to figure out how this saves them money!

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

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Keebler
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For asthma, "medical management" is much different than for lyme.

It does save them money having asthma patients get to doctors for a plan. Millions of dollars are spent in E.R.s for asthma attacks. And asthma can become an emergency very quickly if not well managed.
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INEBG
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Lymetoo, I am wondering why you did not mention Lyme disease to the nurse coaches. I'm still pretty new at this and am never sure how much to trust anyone in the insurance industry. There seems to be a lot of misinformation even amongst professionals.
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map1131
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More and more corp and unions are using these "healthcare coaches". In our circumstance, refusal to allow them access, will deny us insurance coverage period.

My husband is on their radar due to Barrett's Esphogus dx. They call him about every 4 mths to see how he is doing on his meds etc.

I'm not on their radar? They have yet to make one call to me in three years. Most of my medical costs have been rx's and our rx coverage is by a different carrier/the company.

Even though my GI is labeled with "itis", my husband has the serious stuff that is pre-cancer and this says big bucks to insurance if it's not controlled.

So I think eventually you won't be able to refuse these types of medical mgmt co.

Pam

--------------------
"Never, never, never, never, never give up" Winston Churchill

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INEBG
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Just before I was diagnosed with Lyme and coinfections my husband and I applied for long-term care insurance. I am a person who does, and has historically done, everything I know to remain healthy. I eat right, am the right weight, exercise unless I am too sick, don't use drugs or alcohol, have all routine screening tests on schedule, etc. I get my teeth cleaned every three months. Medical tests for the usual stuff always come out great. My husband on the other hand has a high stress job, is at least 40 lbs overweight, and has high blood pressure. He rarely sees a doctor, even for routine physicals. He does not get age-related screenings. He rearely sees a dentist even for maintenance. He does not exercise at all.

During the application process, eyebrows were raised because I had seen so many doctors in the last five years AND he was praised because he had not. Shortly before the insurance application process was completed I was diagnosed with Lyme (finally). As a result, the insurance company rejected my application. However, they said they would accept my husband.

I do not trust insurance companies. I do not believe that a healthy lifestyle is enough to mitigate a diagnosis of Lyme. I'd be concerned that if you put it out there that you have healthy habits, hoping for a break in cost, (especially if you don't mention Lyme) they will question the validity of your need to see a doctor.

Insurance companies are in the business to make money. I do not believe the patients are their focus. I think it is ultimately about profit. Were my medical insurance company to offer me a coaching deal, I would not do it. Surely they already know my diagnosis since my physician has to post a diagnosis code on billing and reimbursement forms. They have a motive to save money; anything they may say or do, in my opinion, that sounds like it is intended to help me is actually to help me help them to save money.

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summerville
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Here presents a very interesting catch 2 for the insurance companies.

On one hand they are saying Lyme can be cured with 3-4 weeks of antibiotics and they give folks a hard time on covering for additional treatments. On the other they won't give you long term health insurance.

Kind of funny isn't it? Seems that if its so easily cured, than it shouldn't present a long term health issue for long term insurance.

Looks like they want to play both sides of the coin!

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Keebler
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I had life insurance revoked when they found out they'd overlooked my mention of lyme. Yet, no MD in my state will treat lyme as "it's no big deal."

INEBG,

In response to my wondering about asking for that bonus for good habits, you said: " . . .concerned that if you put it out there that you have healthy habits, hoping for a break in cost, (especially if you don't mention Lyme) they will question the validity of your need to see a doctor. . . ."

Excellent catch. A very important point and it could backfire as you say, indeed. Also, after more consideration, I think it could be very bad for them to start judging everyone on their habits. I was just thinking out loud but now am reconsidering that idea.
-

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Lymetoo
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quote:
Originally posted by INEBG:
Lymetoo, I am wondering why you did not mention Lyme disease to the nurse coaches. I'm still pretty new at this and am never sure how much to trust anyone in the insurance industry. There seems to be a lot of misinformation even amongst professionals.

I'm not being treated for it any longer. The calls from the nurse have been going on since I got A-fib.

And yes, I don't trust them anyway. They would have no understanding of it.

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

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Lymetoo
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summerville... I have been denied long term care insurance... Like for a nursing home. They said it was because of the Lyme arthritis.

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

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purplemom
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Thank you all for your insight.

This year we have a choice not to do the health coach plan. Next year we are on it--still can decline the $600. Hopefully by then the lyme will be canned.

In the meantime I will research more about what questions they ask and if I can have a copy of their reports. I highly recommend getting written copies of all your medical records. I find it unfortunate some of the things placed in mine and with electronic records EVERYTHING is copied forward often without verifying it with the patient. Some doctors really go to town with their misguided perceptions of some patients--I work in a hospital so I see it first hand. Once it is in there you are screwed. Especially if you have a history of depression, chronic pain and believe you have lyme---very very screwed.

When being evaluated in the ER because I had gotten progressively sicker after a strange flu like illness I asked if the lyme tests were accurate. My dog had been infested with ticks and sat on my lap daily (I know I was stupid) and my daughter was sick (bell's palsy, positive test). I had been treated early on with zithromax (for ? respiratory infection 2 weeks after I got sick) and had been treated with steroids oral and injectable numerous times. I did not recall a tick bite but by that time I realized that many with lyme do not and those buggers are small. So I wanted my question answered--Is the lyme test accurate and what could effect the results? (Such as early incomplete treatment and steroids which I did not know at the time!!!)

The doctor placed in my record that I believed you could get lyme without a tick bite. Jackass did not even know that many people with lyme do not recall the tick bite. He totally screwed with with his history and physical-and I was not hysterical but very clearly wanting correct information.

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