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» LymeNet Flash » Questions and Discussion » General Support » Insurance Battles Driving Me Crazy

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Author Topic: Insurance Battles Driving Me Crazy
MaryL
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Member # 11997

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Is anybody out there going through a health insurance battle? I am soooo frustrated. We have exhausted all appeals & now may have to sue the company to try to get coverage for our 11-year old's IV antibiotics.

They claim he doesn't have Lyme even though he had a positive IgM Western blot & many symptoms. And yes, he gets Herx's on antibiotics. They covered his oral antibiotics, but denied him when he went IV.

We've contacted our legislators & the state insurance commissioner. We've written extensive letters supporting the claim with studies & footnotes & the insurance co. completely discounts the whole deal.

We sent a copy of the Public Law re. Lyme disease, but they come back on the side of the IDSA guidelines & quote the CDC's recommendation not to use the IgM after a patient has had symptoms for a couple of months!

I really need someone to talk to!!!! [bonk]

[ 11. January 2008, 12:46 PM: Message edited by: MaryL ]

Posts: 81 | From Iowa | Registered: May 2007  |  IP: Logged | Report this post to a Moderator
bettyg
Unregistered


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welcome mary to the board. i'm from Ames; where do you live? many support groups in state.

do you have bcbs or who?


please UPDATE MY PROFILE to ENABLE PRIVATE MESSAGES so we can send things privately to you. you have control and can block anyone you wish to ok! thank you.

also, i want to send you my detailed 88 pages of newbie links, advise, symptoms lists, testings, disability info galore plus it has TREEPATROL'S ARCHIVE of over 1000 links of good lyme info!
********************

Mary,

Please break up your solid block text into short paragraphs

Welcome to the board. majority of us here are neuro lymies and can not read long, solid blocks of text like you posted.

would you kindly edit your post by clicking on PENCIL/paper ICON and then break it up in 3-4 sentences unless you are a wordy person, then 1-2 sentences MAX! Also, do NOT breakup a sentence!! Thanks!! 

hit the enter key twice after EACH paragraph as we neuro lymies need this to comprehend and read what you/others post. do this until you are all done ok.

then go to lower left hand corner and mark box to receive all replies to your post.

click edit send; done. THANKS. please do this on all posts/replies. otherwise, we may SCROLL ON BY, SOB, without reading/replying. for me, i just SOB them; too hard on me. PS; I'm also in EARLY stages of going BLIND due to diabetes retinopathy

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just don
Frequent Contributor (1K+ posts)
Member # 1129

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Welcome MaryL from your next door neighbor state to the west.

Insurance problems are ALL to common and are increasingly so,,,because of ducks and IDSA cause thats what they want,,,

Plus EVERYONE knows we dont have lyme "HERE"!!

Just mostly wanted to give you a warm and hearty WELCOME aboard!!!

Plenty MORE have been where your at,,,and SOME have collected after the fact IF they pursue it HARD enough!!

What did the insurance commissioner say?? No help?? Shame on THAT person!!

Thats what usually happens, they cover oral abx and kick up a terrible fuss and refuse IV,,,spose on cost basis!!

When I USED to have insurance they covered a short course and then dropped me like a hot rock. When the port went in they flipped me over to 'managed' care and THAT really sucked BIG time

first they had a sweetie pie sweet talk me into that,,,then transfered me to a hard nosed case worker,,,

THEN to a person I call the hatchet person,,,their job was deny deny deny,,,couldnt even TALK or correspond to THAT person!!

They had the gall to tell my insurane agent that they HAD to keep the costs down OR the whole groups rate would have to go UP.

The ONLY thing they did after that is put me on target to get rid up,,,rates higher by the allowed limit,,,till I couldnt afford it any more,,they drumed me OUT!!!

I would have been paying thousands per month,,, even tens of thousands for NO coverage IF they had their way!!

I think I started out at 80-100 a month when I first started and ended up around 1500 a month and KNEW in a year or two it would be beyond MY means,,,ALL means. so I dropped it!!

They raised it like 40% EVERY year. And I dont doubt they do the same to YOU!!! What company??? Some are worse than others!!

I asked another different company about IF I could get on there,,,they said dont even bother applying,,

,MY ONLY place I can get on with would be Chips or what ever that is!! the state pool of uninsurables,,,BUT that is so expensive too so I take minimal meds and stay OUT of hospitals and ER's!!

SO maybe check into getting your 11 year old ON the state plan IF it would cover the IV stuff and other good meds and treatment from now on,,,IF they are going to pull same crap,,,NOT!!

There ARE good agents who can check on such stuff without getting their pinkies pounded on!! Basicly Insurance is SUCH a racket!!

Even homeowners and ONE claim and your out,,,OR their stupid credit checks and surcharging you IN CASE you burn your house down!! More stupid than fact!!

Good luck,,,IF you are striking out at this point,,,LOTS more heartache to come!!! SAD but partially true at best,,,,,, remaining --just don--

--------------------
just don

Posts: 4548 | From Middle of midwest | Registered: May 2001  |  IP: Logged | Report this post to a Moderator
hanginginthere
LymeNet Contributor
Member # 11685

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Hi Mary,

I just wanted to let you know, you're not alone in your fight with insurance! Unfortunately, it's all too common.

I was given two days notice that my IV would no longer be approved! I've exhausted my appeals and am now in search of more affordable IV sources since I will be on my own [Frown]

Check out the link at the top of General Support--the one that offers help with insurance, disability, etc. There are a lot of great ideas there, including a copy of Timaca's appeal letter to her insurance for IV.

If I didn't have the notorious BCBSNC (who persecuted our dear Dr. J), perhaps I would have been successful in my appeals. Definitely hang in there and give it all you've got. It's frustrating, but at least you'll know you've done everything you can. [group hug]

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MaryL
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Member # 11997

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Thanks BettyG for the tip on breaking up sentences. And, yes, I am a wordy person.

Am from Grinnell, but not many in our group - mostly RELATIVES who have Lyme & I talk to them regularly anyway.

Traveling to another town's support group is hard since my son is going to school still & we do infusions at night when most groups meet.
So, I'm trying to do this on-line.

Insurance Co. is Assurant. Have looked through
the tips, but still can't find a resolution.

Posts: 81 | From Iowa | Registered: May 2007  |  IP: Logged | Report this post to a Moderator
MaryL
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Member # 11997

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Thanks, just don, for the welcome.

In our state, the co. that covers uninsurables does not cover pre-existing conditions! My previous mental health condition is excluded even several years later. I am one of the state's "uninsurables" & so am on that plan.

Otherwise, it's a good plan & it covered my IV abx when I contracted Lyme. Just wish I had my son covered under it now.

Posts: 81 | From Iowa | Registered: May 2007  |  IP: Logged | Report this post to a Moderator
bettyg
Unregistered


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mary,

an idea for you ok! i've got a good friend on the board who was in the insurance co. business prior and has some insight on this type of thing.

send him a private note and include the link for your post here please.

subject line; bettyg sent me to you for insurance advise!

OOPS! i expected you to get out your crystal ball to get the member's name! [Big Grin] [lol]

member's name is NP40; so go to DIRECTORY at top of page under new post, click it.

where you see the line to type on, type his name there bringing up his profile;

go to right corner, and send him a private message from there!

then ask more questions, etc. i know he's working again so it may take some time to get a reply but he's very PROMPT on answering otherwise!

2nd tip,
*********
hopefully you hav filed my 88 pages into word, etc.

use EDIT, FIND, type in Timaca
keep hitting enter until yu find her INSURANCE COVERAGE LETTER WHEN SHE GOT IV APPROVAL!!


are you the wife of a lawyer there where i may have met at ames s.g. meetings 3-4 years ago? you'd just gotten an iv port that day? your/hubby's parents were there too? you can answer here or by private message ok! [Big Grin]

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MaryL
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Member # 11997

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Hi BettyG. Yes, I am one & the same person. Sorry I don't remember much about that time. Lyme fog was really bad about then.

It's my parents (Mom & step-dad) who were there also at the meeting. All 5 of us contracted Lyme at a home renovation project where cat fleas were thick.

My son got worse after I got better & he ended up in a wheelchair because of the leg pain so we had to have him go on IV also. Unfortunately his insurance is different than mine.

Thanks for lending an ear. [Smile]

Posts: 81 | From Iowa | Registered: May 2007  |  IP: Logged | Report this post to a Moderator
bettyg
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mary, wonderful meeting you again after all this time!

i see you still have NOT UPDATED MY PROFILE to allow PRIVATE MESSAGES be sent to you.

so i can't send you my 88 pages of info where i mentioned to do a search on timaca letter i discused above.

lots of good, other info in my newbie package, and is 40-50% different than TREEPATROL'S ARCHIVE of over 1000 sites of good lyme info!

met you again in ames when that out of state IDSA duck came to ames and spoke about lyme disease in hospital aud! later... [group hug]

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