posted
That was amazing to read - more politics
Posts: 582 | From milwaukee wi | Registered: May 2005
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minoucat
Frequent Contributor (1K+ posts)
Member # 5175
posted
This is awful. They were our insurance company at one time, and we had to beat back endless denials of care.
From the policy: # Aetna considers outpatient intravenous antibiotic therapy medically necessary in adult and pediatric members with the diagnosis of Lyme disease only when it is based on the clinical presentation of signs and symptoms compatible with the disease and supported by a positive serologic and/or cerebrospinal fluid (CSF) titer by indirect immunofluorescence assay (IFA), Prevue Borrelia burgdorferi antibody detection assay, or enzyme-linked immunosorbent assay (ELISA), which itself is validated by a positive Western Blot Test (see CDC criteria in note* below).
posted
Interesting that they get away with this, given the fact that both the CDC and NIH (which are otherwise doofuses on lyme, etc) say that it is a clinical diagnosis.
When I say doofus, I really mean criminally incompetent.
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
Aetna just paid for 2 months of IV rocephin a few months ago for me. They paid for my very expensive spec scan, western blot testing and some of my LLMD charges(about 1/2 a what she charges, since they pay 70% of reasonable and customary, not 70% of what your doctor actually charges !!). I am having trouble getting reimbursment for a few other Lyme tests this year, but my doctor thinks this can be resolved. Anyway, it's no worse than anywhere else.
Unfortunately, since this insurance is thru my ex's company, I am about to lose it. And, believe me, Aetna coverage is 1000% better than what I will have, which is medicare, which will cover 0% of my LLMD, and 0% of my presriptions. Which may mean I effectivly will stop any lyme disease treatment.
I have also had great presription coverage thru his work, a $15 copay for 2 weeks of Flagyl, for example.
I do agree that Aetnas' bulletin is garbage. And, if they decide a particular doctor visit or test is not "medically necessary" there is no way to figure out why they said that.
But, believe me, it is better than most, and tons better than nothing.
Posts: 222 | From Santa Cruz Mountains, CA USA | Registered: Nov 2004
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