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» LymeNet Flash » Questions and Discussion » General Support » Interesting personal insurance battle

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Author Topic: Interesting personal insurance battle
kitkat32
LymeNet Contributor
Member # 9682

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Good evening everyone,

I thought I would share something interesting that happened today.

I had LLMD appt. yesterday. I was put back on Zithromax and Flagyl. Zithro was increased to 500 mg.

When I first did this combo my insurance only agreed to pay for 20 tablets a month. LLMD office really had to push for that and it went to the review board with insurance.

I went to pick up new script at pharmacy yesterday and was told insurance would only pay for 4 pills a month.

I called LLMD office this morning and told them they needed to call my ins. and it would have to go under review again. Pharmacy called me this evening to tell me it was all approved.

I called LLMD office back and this is what they told me they did to get approval.

Instead of giving the insurance co. a diagnosis for lyme and co-infections they took every one of my 30 symptoms and matched it up with a code. The receptionist told me the insurance company quickly agreed to approve a 30 day prescription that is good for the next year.

Can you imagine the look on the review boards faces when they are presented with 30 diagnosis codes????? [bonk]

I am really proud of my LLMDs office for doing this for me. I know it must have taken them awhile to pull all that together.

Just thought I would share something good for a change. It might be an idea for others to use in the future.

kit [Smile]

Posts: 655 | From Pennsylvania | Registered: Jul 2006  |  IP: Logged | Report this post to a Moderator
Aniek
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Kit,

Thanks for sharing. My LLMD always puts multiple diagnosis codes on everything. It makes a big difference with insurance.

--------------------
"When there is pain, there are no words." - Toni Morrison

Posts: 4711 | From Washington, DC | Registered: Mar 2004  |  IP: Logged | Report this post to a Moderator
LaurenTurner
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That's wonderful!! [woohoo]

Looks like you have a very caring and nice llmd on your side. [Smile] That is great.

Posts: 248 | From Tejas | Registered: Jun 2007  |  IP: Logged | Report this post to a Moderator
perplexed
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Member # 1913

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Even in non Lyme medical issues, it is all up to those darn codes and how the MDs code the paperwork to the insurance companies.

So happy it worked out for you.

Hugs, Perplexed [woohoo]

Posts: 324 | From Lexington, KY, USA | Registered: Dec 2001  |  IP: Logged | Report this post to a Moderator
bettyg
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whoopie kit; way to go and especially to your drs. office staff! [Wink]
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Boomerang
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Good for you, kit!! Thanks for the info. Much appreciated.

Hope you are doing better.

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trails
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awesome.

very kind of your LLMD to do this.

hold on to them!

Posts: 1950 | From New Mexico | Registered: Sep 2001  |  IP: Logged | Report this post to a Moderator
   

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