I need some help with an insurance issue. My insurance company will not pay for my visits to my LLMD. They say that my Dr. is not billing with the proper procedure code. I have sent them copies of office notes and they request more info from the Dr. I believe the Dr. has not sent more info because my lyme test is not positive it is equivicol.

Who should I talk to to help with this problem? I am unsure whether I should even pursue this, because so far insurance has paid for all of my medication, including 1 year of mepron/zithromax. I would appreciate any ideas.

Rene

 

There might also be a chance that your plan doesn't cover out of network visits (assuming your LLMD is out of network, like most).

Double check your insurance plan to make sure out of network coverage is not the issue, then ask your LLMD to use a different procedure code, if that's indeed the problem.
 

Since you're saying that the insurance company is complaining about wrong codes, it doesn't sound like an issue of covering out-of-network.

I doubt if it matters what your doctor thinks about your having Lyme disease or not, or what the tests showed. The office visit should still be covered.

I would double check that the doctor used some valid office visit codes.

Here's the office visit codes that have been used by my LLMDs:

99205 initial/new comprehensive visit
99215 established comprehensive visit
99214 extended visit

Here's some diagnosis codes that have been used by my LLMDs:

088.81 Lyme disease
348.3 ?
368.8 ?
719.4 Arthralgia
780.4 Vertigo/dizzyness
780.71 Fatique
780.79 ?
780.93 ?
780.99 Memory loss
782.0 Parasthesia
784.0 Headache

All of the above codes were accepted by my insurance company (Aetna) as valid out-of-network charges.

Michael