posted
Hey all! I hope we are all doing well on our quests to good health. I haven't posted in months, i have been in remission from searching for a diagnosis. the summer has been too nice for all of that.
Anyway, I am getting back into the search and I am actually going to see a holistic lyme/immune system specialist/neurologist soon. I was tested through igeneX in May and the results were negative, but close to positive, with one lyme specific band + and another IND.
I am trying to be reimbursed for the tests, and my insurance company has sent my claim back, because i am missing a "diagnosis code." I am guessing this means they wont help me out unless I tested positive for lyme through igeneX? did anyone actually get money back with negative results? If so, how do you obtain this code...
At this point, reimbursement is the least important goal I have set. Finding a diagnosis is up there though...
I still haven't been able to rule out lyme or lupus. They are just so darn similar!
Thanks for the insight..
Be well, Michelle
Posts: 55 | From portland, or, | Registered: Apr 2006
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You can get the diagnosis code from Igenex, I think. If not, your LLMD will have it.
My test was CDC negative, but I'm pretty sure my insurance paid for it. That was 6 yrs ago, so it's hard to remember!
Just remember, you have nothing to lose by treating for Lyme with abx, but EVERYTHING to lose by taking steroids for "lupus."
Keep us posted on your journey!!
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96227 | From Texas | Registered: Feb 2001
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bettyg
Unregistered
posted
pru, I've got your answer since it happened to me too! I used to have detailed info in my newbie links I send to those just joining, but lost my software and they went to never-never land!
Bottom line: IGENEX has their own required downloaded form, and someone from your MD's lab who drew the blood, forgot to transfer the MD's DIAGNOSTIC CODE for the illness they think you have, NOT NECESSARILY LYME DISEASE, but whatever that MD thinks is wrong with you ok!
CALL YOUR MD FOR THAT DIAGNOSTIC CODE NO. Then call your insurance co, with that info.
Calif. BS office sent the paperwork back to IGENEX for the code; they said they attempted to call or fax my MD's office, but NEVER did.
So after 5 people involved, my local clinic sent it back to me 8 wks. after I sent it the 1st time! Boy, was I mad for spending 2 hrs. talking to my clinic, Iowa's BCBS office, Calif. BS office, and Igenex ... each 3 times!
Bottom line: Iowa's BCBS paid me only $43 out of $180 since Igenex was OUT OF NETWORK!
So it's a good reminder to those getting IGENEX's western blot igm/igg to make sure when they download OR IGENEX SENDS YOU THEIR KIT W/THEIR FORM INSIDE, to:
X areas for diagnosis code, MD's signature/date, etc. so it isn't overlooked prolonging reimbursement to you.
Also, good time to write on Igenex form also to FAX results to MD and snail mail paper copy. Someone lost my paperwork for 4 weeks!
posted
Positive or negative results have no bearing on whether or not insurance will reimburse you.
Doc should be able to provide the diagnosis code. To speed up process ask the doc to give you the code and you add it to the form to send to IGeneX or your insurance company if you are filing it yourself. Don't ask the doc to send the code to IGeneX directly -- better if it goes on the form itself (can't get lost that way).
If you have a copy of your superbill from the doc appointment when the test was ordered, the code should be on that paperwork. There could be more than one code. Lyme is 088.81 I think.
Actually it is a good idea to get familiar with the diagnosis codes. Hubby is having a problem with insurance premium ratings because at one point a nurse put a diagnosis code of congenital hemophilia on a blood test for hypercoagulation. Wrong codes can come back to haunt you. We actually consulted with a lawyer last week about this as insurance is being obstinate.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
I have Medicare and it covered it for me. I agree with Bea about it not needing to be positive to get reimbursement.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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