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» LymeNet Flash » Questions and Discussion » General Support » INS. CO. SAYS NO FOR LLMD

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Author Topic: INS. CO. SAYS NO FOR LLMD
bill+1
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[Mad] [Mad] [Mad]
WE did the referral through my MD like were suposed to but the ins. said no coverage for out of network MD .

My cse worker said he's not board certified in any special field and I should see an innetwork
ID.

I tried to explain what a LLMD was for a lyme patient and the innetwork ID does not treat chronic lyme only symptoms . Been there already.

We talked for some time but I just could not get them to understand chronic lyme or maybe they don't want to know .

I'm still going to keep my appointment but financially( over look my spelling) I can't go long term treatment .

Any suggestions on how to presure the ins co ?

I have Health Alliance in Il.

Thanks for any ideas [bonk] BILL

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Wishing us all well !

Posts: 99 | From Southern Illinois | Registered: Feb 2010  |  IP: Logged | Report this post to a Moderator
Tincup
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Sorry to hear.

When you don't get the answer you want.. call again another day.

Go with the fact that NO docs in their plan treat CHRONIC Lyme.

Period.

If they say there is one .. make THEM call and ask. Make THEM find someone for you by making the contacts.

Tell them ID ducks don't treat CHRONIC Lyme. Period.

Tell them you can't go to an ob/gyn for a foot problem, so who are you suppose to go to for CHRONIC Lyme?

Don't give up!!!!!

Good luck!

[Big Grin]

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

Posts: 20353 | From The Moon | Registered: Jun 2004  |  IP: Logged | Report this post to a Moderator
Keebler
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-
Try this dx: neuroborreliosis
-

Posts: 48021 | From Tree House | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
bill+1
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thanks tincup , i'll give them a call monday morning

keebler i'll throw that one at'em monday also .

thanks

--------------------
Wishing us all well !

Posts: 99 | From Southern Illinois | Registered: Feb 2010  |  IP: Logged | Report this post to a Moderator
Lymetoo
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Look at your papers from the doctor. He may have written "neuroborreliosis" on your diagnosis.

But still... PUSH.

It all depends upon an individual's insurance company. Mine would pay 80% for awhile and later I think they paid only 60% .. but that figure "saved my life!"

Get all your paper work from the doctor and if you can afford at least one more visit later, you will have enough "ammunition" in order to treat yourself perhaps!

Not the ideal situation, but you do what you have to do.

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

Posts: 95817 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
sutherngrl
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Put everything in writing. Write letters and keep copies of all letters. Also send the letters to your regular MD, the one that made the referral, and make sure the insurance company knows you sent it to him. Having things in writing goes farther than just speaking to someone. Maybe have your regular MD get in contact with your ins co also.

Its also possible that your LLMD will put down a diagnosis that the insurance company would actually be willing to pay for. If not see if you can spread your appts out; and possibly your regular MD, although not likely, will work with your LLMD.

Posts: 4035 | From Mississippi | Registered: Jul 2008  |  IP: Logged | Report this post to a Moderator
RESOLVED.
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If you don't have neuroborreliosis as a dx, maybe try dx:dysautonomia. Since Lyme messes with so many systems, maybe you could find SOMETHING they'll cover. Most of us are in the same situation, it's despicable.

And Bill, don't worry about your spelling, none of us can spell anymore!!! [Smile]

Posts: 246 | From south florida | Registered: Mar 2010  |  IP: Logged | Report this post to a Moderator
randibear
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i spent months trying to get bc/bs to reimburse.

i finally gave up and just paid out of pocket.

besides i didn't want my file "red tagged".

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do not look back when the only course is forward

Posts: 12262 | From texas | Registered: Mar 2007  |  IP: Logged | Report this post to a Moderator
Rene
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Always appeal. Fight to the bitter end, even if you don't feel like it. My husband and I have appealed every denial and won. Never give up!!!
Posts: 366 | From Louisville KY. | Registered: Nov 2003  |  IP: Logged | Report this post to a Moderator
pj1954
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bill do what I did make copies of the llmds bill , send it to your insurance and see if they will send you a check for your out of pocket expenses.

of my initial visit they only reimbursed me $240.00 but its better than nothing !

Posts: 294 | From sw chicago suburbs | Registered: Apr 2007  |  IP: Logged | Report this post to a Moderator
pj1954
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bill do what I did make copies of the llmds bill , send it to your insurance and see if they will send you a check for your out of pocket expenses.

of my initial visit they only reimbursed me $240.00 but its better than nothing !

worse case scenario keep the bill for your taxes and if you have enough dollar total you can get a refund for uncovered medical expenses !

Posts: 294 | From sw chicago suburbs | Registered: Apr 2007  |  IP: Logged | Report this post to a Moderator
sixgoofykids
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I didn't get reimbursed for my doctor bills, but never tried since I know they don't cover phone consultations anyway, so we were only talking about 3-4 visits per year. More importantly, my meds were covered as long as they weren't meds for Lyme that needed prior approval ... ie I could take Biaxin, but not Zithromax. I had no trouble getting meds for coinfections, they approved everything.

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sixgoofykids.blogspot.com

Posts: 13449 | From Ohio | Registered: Feb 2007  |  IP: Logged | Report this post to a Moderator
Lymetoo
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quote:
Originally posted by pj1954:
[QB] bill do what I did make copies of the llmds bill , send it to your insurance and see if they will send you a check for your out of pocket expenses.

I think there is hope that they will still pay part of it. The paperwork may fly under the radar. Your dr probably listed the dx as "borreliosis".. the ins company may overlook that .. not realizing it is Lyme. I never had any trouble with my insurance, thank goodness!!

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

Posts: 95817 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
bill+1
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Thanks everyone for the input .It is much apprieciated .

I checked in with the V. A. they go buy income and property value over 5 acres to detirmine a copay.
Then they said they would bill my ins. co. for the rest. Don't know how that would turn out in the long run .

--------------------
Wishing us all well !

Posts: 99 | From Southern Illinois | Registered: Feb 2010  |  IP: Logged | Report this post to a Moderator
Lymetoo
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Well, anything is better than nothing!!

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

Posts: 95817 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
   

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