Yes.. another poll question. Thanks for helping out.
I would like to know..
YES or NO.
If you HAVE it....
Have you had any trouble getting insurance to pay?
Posted by Foggy (Member # 1584) on :
Tin, what's up with all the polls? You running for office?
I'm happy to buy a pencil from your "tincup" but my incalculable "lost income" went towards my treatment for countless MDs that my insurance co wouldn't pay for. <>
What happened to your class action lawsuit from '01?
[This message has been edited by Foggy (edited 28 February 2005).]
Posted by Lenny777 (Member # 5452) on :
They wouldn't pay for my Bicillin. I was out about $800-1000 before I changed abx. Other than that they've covered pretty well.
Posted by monkeyshines (Member # 6406) on :
Yes (my old insurance)
No (my new insurance, so far)
Posted by Tincup (Member # 5829) on :
Foggy...
The folks we could get help for.. got help back then.
No trouble, so far.
Posted by WIZARD (Member # 4597) on :
Very fortunate that insurance has covered all expenses so far.
Not so fortunate with the lost income.
Posted by Kari (Member # 4154) on :
The only major problem I've had with my insurance company is finding adequate "in-network" providers which they will pay at 100%. Most of the LLMD's are out of network and also the infusion service which I get my IV abx is out of network, but they will still pay 60%. My insurance also has an annual out of pocket max of $8,000.00, which was a saving grace last year.
Posted by JillF (Member # 5553) on :
I have not even tried to get insurance to pay. I know they are too cheap.
They will pay for my medication but that's it.
So it's out of pocket for the llmd visits (he is not on their 'list' for doctors to see) and igenex testing
Oh, my old insurance (blue cross) only allowed me 6 pills of Zith (I took 2 a day) for $20. So every 3 days of Zith cost me $20. I found that ridiculous!!!!!!!
[This message has been edited by JillF (edited 01 March 2005).]
Posted by arg82 (Member # 161) on :
Yes for one of my old insurances.
My current insurance was doing well until this past week. I'm now having to fight for non-antibiotic treatment (daily IV hydration to help with neurocardiogenic syncope and energy level). This is partially due to my dr.'s office screwing up, but that's another post.
No trouble with insurance.
Posted by lisag (Member # 6798) on :
Yes, don't cover llmd services. Also can't find any docs in network who will go along w/dx.
So far meds have been covered...
Posted by minoucat (Member # 5175) on :
Yes.
Trouble on 5 separate occaisions paying for medicines, with 2 out of 4 different insurance companies. Worst problems were with IV meds.
Ins. payment for visits to LLMD and for some blood tests has mostly been neglibible to non-existant. (That is, I pay about 90% of these costs myself).
My experience with medical insurance varies from excellent to nightmarish.
Posted by vandeb (Member # 6345) on :
my insurance company so far has been great........
------------------ Debbie V.
Posted by yankee in black (Member # 4309) on :
No problems what-so-ever
Posted by MADDOG (Member # 18) on :
Insurance allmost cost me my life,their refusing to pay for the lyme specialist ,caused me the loss of my gall bladder.The ins, has never paid for what I need or for the doc. I need. I call them United No Health care. MADDOG
Posted by hwlatin (Member # 4123) on :
No problems with insurance here either.
Posted by ShadowHawk (Member # 6263) on :
No problems with insurance whatsoever.
I'm overweight as a result of the hormone problems and was considering Gastric Bypass as a means of dealing with the weight. Insurance agreed to pay for the bypass, but had noted the hormone issues from previous test results. They contacted me and suggested I seek treatment for the hormomes before doing the surgery, knowing full well that the hormones could end up costing them more.
???
I can't say enough good things about my insurance co.
Posted by teri64 (Member # 6971) on :
Yes... had trouble getting more than 4 weeks IV. They eventually extended it... by 2 weeks.
Posted by lhm312 on :
Only trouble with insurance was in getting an adequate number of weeks for IV Rocephin. They stopped paying after 4 weeks, fought for more and got an additional 2, that was all.
Posted by kam (Member # 3410) on :
HMO=====YES
PPO======YES
MediCAL------YES
Posted by Paisley (Member # 6502) on :
oh yeah....all my insurance companies have tried to get out of paying for treatments by using the prashing "beyond reasonable and customary" blah blah blah
Posted by Paisley (Member # 6502) on :
I applaud your work (and anyone else involved) in this worthy cause. I'm sure you are working your butt off to give us a voice.
I realize that the Northeast has been hit particularly hard by these issues, but in your humble opinion, how do we get similar hearings for other regions of the country. For example, although I was infected in the Northeast, but now live elsewhere, how do I (and others in similar position} feel like we can participate and get fair representation in othe states who are so far behind, they don' t even know what Lyme is?
Posted by fatigued15 (Member # 6437) on :
They have denied all my claims and have deniied all referral my peditrician has put in for lyme doctor and labs. I think is only a matter of time that they will deny ABX if they are ordered by our lyme doctor. They are saying he is out of network and someone where I live can treat. They will not tell me who that mysterious person is.
Posted by James H (Member # 6380) on :
No problems yet.
[This message has been edited by James H (edited 04 March 2005).]
Posted by Mathias (Member # 5298) on :
Not yet. They are covering doctor costs at out of network rates. Abx have been covered in full (minus co-pay).
Posted by hiker53 (Member # 6046) on :
Yes--insurance stinks.
Posted by HEATHERKISS (Member # 6789) on :
yes
Posted by Wink9 (Member # 4516) on :
Yes, I have had problems.
Posted by Beverly (Member # 1271) on :
No
Posted by Nal (Member # 6801) on :
Im not sure what they will be willing to cover yet. I have wonderful Tricare. I filed some claims last week. If the person reviewing them is having a good day, they might pay some. If he's having a crappy day, probably none at all! We'll see.
Nancy
Posted by deb obrien (Member # 5239) on :
no - i have medicare - almost all tests have been cover3ed as have doc visits - as you know there is no drug coverage, deb
Posted by Kira (Member # 2676) on :
Initially there was an issue with IV abx till LLMD brought up the positive PCR...no problems since then...
In-network coverage hasn't been a problem, but Out-of-network docs, tests, services, have frequently required me writing letters of appeal (which is a major headache when I am ill) but eventually, things get reimbursed...
Posted by Cheryl (Member # 75) on :
Well, have had many plans. But basically...
YES for IV/IM - Oxford HMO the worst.
NO for orals and most tests.
PS. Perhaps I should add that Oxford did gladly pay for the hospitalizations that I needed as a result of them denying the IV. GRRRRRR.
[This message has been edited by Cheryl (edited 01 March 2005).]
Posted by LymeinME (Member # 6849) on :
yes
Posted by bg (Member # 46416) on :
We have BC/BS and it's 80/20..that we pay plus $15 per office visit/lab/xrays,etc.
No problems with insurance whatsoever EXCEPT for:
being reimbursed for IGENEX's western blot IGM & IGG blood tests..
since they do NOT accept insurance, Blue Chip Calif. only paid me $43 vs.
over $120 out of my $180 prepaid costs IF Igenex would have been on APPROVED list of blood labs to do this testing by BC/BS.
Betty G., Iowa
[This message has been edited by bettyg (edited 05 March 2005).]
Posted by Tincup (Member # 5829) on :
Great help so far.. but this catagory is lowest on responses.
Any more answers from anyone?
Still trying to reach 100 reponses.
Thanks!
Posted by jewood69 (Member # 5945) on :
No (A little slow though)
Posted by Neil M Martin (Member # 2357) on :
Among lymites my HMO's surname is "Could Care".
Does that answer your question?
nm
Posted by needleseye (Member # 6037) on :
We have catastropic coverage in an in state PPO with $40 office visit co-pays.
They paid the initial co-pays.
Nothing else has been covered including the out of state LLMD
Posted by MonaR (Member # 6972) on :
Yes
They have paid for 5 months of IV daily Rocephin (so far) and daily nurse visits! For this I am grateful.
MAMSI, who is now part of United ;(, does however give providers a hard time, demanding notes for every visit and they almost cost me my Lyme dr! She was dropping them and I would not financially be able to continue seeing her. Luckily she ended up signing a new contract with them but they are still demanding of providers.
They will only pay for the minimal dose of anti-virals and the dr gives me samples for one pill per day.
They also make the dr write letters (basically an appeal) for 2 scripts each time they get renewed.
They do cover testing through MDL which is wonderful.
------------------ Ramona
Posted by Rene (Member # 4870) on :
Yes, The insurance will not pay for LLMD visits, but have paid for the medication so far.
Posted by Walnut (Member # 6585) on :
NO -- except for certain drugs, like zithromax and diflucan. Have got IV treatment covered in the past without a problem.
Posted by lymesux (Member # 6248) on :
yes
Posted by pomegranite (Member # 3339) on :
My insurance reimburses me at out of network rate for LLMDs and sometimes reduces the total rate allowed before applying the percentage formula. So while they say they pay 80% for out of network docs they paid less than half for my visit to a NY specialist.
They have covered all my meds so far, but I'm not on IV at the unbelievable rate of $5 per prescription for brand name.
They cover my labcorp tests 100%, Columbia Spect 100% (in network).
They cover Igenix, MDL and stonybrook pretty sketchily...can't say exact %, still working this out w them.
I feel blessed~ Pomegranite
Posted by lymemomtooo (Member # 5396) on :
Insurance pays most of the medicine expenses but the Dr's are out of network and my husband is fighting for some of them currently.. We are responsible for 20% currently, for the things they reimburse.
Posted by Pitnum (Member # 4906) on :
I have had ongoing problems with the insurance company. They initally approved treatment, then tried to back out after they saw the total expense for IV treatment.
I have had positive test results, but they insist on ongoing positive results to pay for any future treatments.
They want me to go to a LLMD in network, but they don't have one! They continue to refer the case to infectious disease Dr's, but they end up sending it back to the LLMD.
Posted by cindy_leigh (Member # 3514) on :
no, thank God
Posted by lightfoot (Member # 2536) on :
Yes
------------------ C O L O R A D O * S U P P O R T * S Y S T E M [email protected]
"A friend is someone who knows the song in your heart and can sing it back to you when you have forgotten the words". Unknown
Posted by duramater (Member # 6480) on :
Way back when, I did have one treatment that the insurance approved and then elected not to pay. Filed a department of insurance claim (NJ), and they were ordered to pay it in full.
Of course a related question is, how many have trouble getting LLMD to ACCEPT insurance. So many have opted out of Medicare alone (this knowing that many patients are disabled....) That sucks too.
Posted by bg (Member # 46416) on :
TC,
Had you thought about copy/pasting your 4 questions to OFF TOPIC to and emphasize it's LYMIES, not sarcoidosis, that you want responses from: www.marshallprotcol.com
I bet many there would love to contribute to your 4 poll questions to take to your Penn. legislative committee this Thurs!
Betty G.
Posted by NP40 (Member # 6711) on :
NO Problems.............
..............so far
Posted by proud pup (Member # 4152) on :
Ours has payed for all meds but one.
Its covered all IVs so far (9 months worth)
Only problem has been LLMDs do not except ANY insurance. And thats expensive for 3 family members.
Posted by Melanie Reber (Member # 3707) on :
yes
Posted by BOEJR (Member # 1734) on :
they where paying for the Zythromax, Bicilllin and the Provigil. But as of dec 04 they no longer pay for Provigil, have limited the payment for Zythromax to two weeks supply.
And if I wanted to stay warm for the winter I could use all of the denial letters. that we all know as EOB's
boejr
Posted by cmichaelo (Member # 5873) on :
So far so good.
Though it has only been 8 months, and I'm not on IV.
Michael
Posted by beach4so (Member # 3832) on :
YES, YES, YES,
I have to appeal everything and even then I am lucky if I get them to pay 50%.
There big excuse is everything is out of network, even then they are suspose to pay 65%.
Most of time they pay around 35%, even after appealing.
Starr
Posted by Lymetoo (Member # 743) on :
No, except I've had to file a few appeals. Always won.
Posted by Mo (Member # 2863) on :
No trouble on orals no matter what or how long..
YES on what the case manager mistakenly let slip referance to:
the [b]"high dollar"[b] drugs. (IV)
It appears we no longer had the illness when the costs were higher.
Hmmm...
Mo
Posted by hatsnscarfs (Member # 6562) on :
Yes, my insurance simply doesn't cover the number of Drs. visits/tests I need.
Posted by pq (Member # 6886) on :
yes
Posted by sarahjane (Member # 6517) on :
Have insurance with international company out of Germany- no trouble at all so far-
Posted by bg (Member # 46416) on :
TC,
After you get done eating all that ice cream and shaking your tutu during your R & R after your Maryland hearing this Thursday, yes, I/others would be interested in the answers to all your poll questions.
This way we have some evidence for our states too and health depts.
Now, take 12 deep breaths, and you'll fall asleep now.
Don't worry; you're going to do fine and represent ALL of us lymies well Thurs.
I'd like to be a mouse in the corner to hear all the activity of the day's events! ha.
Betty G.
Posted by morningnewsman (Member # 5987) on :
My insurance will not pay ANYTHING! It cost me $600 a month for visits and medicine, and the insurance company says they will not pay for out of network doctors when they have doctors who will treat me. The problem is, those doctors will not treat me the way a competent LLMD will.
------------------ Thanks, Rick
Posted by Dream4Distance (Member # 7005) on :
YES.
They haven't given me trouble over oral antibiotic treatments, but IV they've rejected claims for despite appeals, test results, evidence, and all the jumping through hoops they asked for (my family was forced to pay out of pocket for IV treatment after an initial claim and a round of appeals just ended up wasting months of time I could have been spending getting better).
d4d
Posted by nannie (Member # 5250) on :
YES.
Unfortunately, my LLMD refuses to assist with these issues. "we don't take insurance". Does a lab participate with my insurance?"Because we don't take any insurance, it is not our responsibility" The new trick seems to be for the LLMD to phoneconsult with my other treating physcians. He bills and gets paid, they don't.
MY PCP who does take insurance is getting stuck doing all of the appeal work for a lot of the big name LLMD's. The LLMDs are also passing off all of their liability to PCPs.
When you see an oncologist for cancer treatment, the oncologist does not write a note to the PCP and ask them to prescribe chemo. Why are some LLMD's doing this? When the insurance company denies chemo, the oncologist does not expect the PCP to write the insurance appeal, so why do some of the LLMD's?
LLMD's who leave their patients financially liable for their care and for their treatments and lend little credibility to their cause. I don't like being put in the middle of an LLMD and other MD's, and that seems to be where some of the better known cash practice LLMD's are taking this. No good will come of it.
Posted by Tincup (Member # 5829) on :
Please try to respond if you have not.
Posted by rcmdesigns (Member # 5922) on :
no, uninsured, unemployed
Posted by Lymiedad on :
Yes
Posted by lymeam2pm (Member # 6103) on :
Keeping mt fingers crossed - YES so far!
Posted by treepatrol (Member # 4117) on :
Yes & No
Yes all medical paid. No Except I had to submit igenex stuff for reimbersment.
Posted by DC (Member # 6633) on :
Yes and No.
My regular insurance is paying. Workers comp insurance is fighting me on Lyme being an occupational diesase.
Posted by Jooooo2 (Member # 1621) on :
YES!!!!!!! " Principal Financial Group"
They agreed to pay and then backed out after 6 weeks of treatment. Then questioned every medication or Dr.s visit from that point on.
Jo
[This message has been edited by Jooooo2 (edited 08 March 2005).]
Posted by Monica (Member # 224) on :
No. Not yet.
Posted by SuZ-Q (Member # 5903) on :
We weren't able to get coverage for IV gamma globulin, so we had to forego that treatment. Her IGG's test out low, but I guess not low enough to satisfy insurance requirements.
Posted by achey (Member # 6284) on :
so far so good...but it took some work LLMd's office contacted a non profit mediation co that worked btn dr's orders and got insurance approval and waiver...
e.g.- insurance requires 3 days in pateint hospitalization prior to home nursing care and home infusion therapy...got that waived.
I still have to constantly check up on all forms to make sure ins co pays as stated..
Posted by ShelleyA (Member # 49) on :
Yes..........depending on the insurance ....some policies require that we only use their labs and doctors........so that doesn't covered Bowen or Igenex or Smokey Mountain labs or anything else fancy. At the moment I can have 3 EKG's in my lifetime.......duh.........I have prolaped valves and am hypotensive......and so it goes.
Posted by Linda LD (Member # 6663) on :
Tincup,
no problems yet--but we are only taking one abx a month so we can continue to work and so we can stay under the radar of the insurance companies. We just changed insurance but I understand people on BCBS (my insurance before I got layed off last year--is reallly hitting their people hard and fast. If we had more confidence in the insurance we would take more medicine--but we are in diar straits and must keep our jobs or risk losing the house.
L
Posted by Mowanda on :
Hi really knew to this so not sure I will be too helpful. We are military which automatically covers everything provided you work within there system. I have a more limited selection of doctors and the procedures they will try. I'm not sure to what extent this will limit me with treatment, I will find out more tommorow as I talk to one doc about finding the best availbe doct to treat. I think with enough justification they will provide and cover for most procedures. The biggest challenge will be to find the right doc willing to try in a time period acceptable for treatment.
Posted by IBelieve (Member # 6834) on :
No problems at all. Both IV and oral antibiotics.
Posted by nan (Member # 63) on :
NO
Pays to be old and on Medicare.......
[This message has been edited by nan (edited 08 March 2005).]
Posted by Ms. Myoclonus (Member # 6750) on :
no problems yet, but have not been on IV
Posted by laserred (Member # 6796) on :
Yes, but still waiting to find out if my alternative Ins will cover it.
(Husband is a 100% disabled veteran, so we have VAChamp, LLMD submitted it, so still waiting to find out).
I don't know if that was any help or not???
-laserred-
Posted by DJP (Member # 5893) on :
Yes, so far they paid for my daughter's test and antibiotics.
Posted by mbroderick (Member # 5220) on :
Jordan has been under treatment since January of 2004 and has been on constant oral antibiotics on some sort or another since then. All antibiotics and other Lyme-related prescriptions have been paid for (aside from my copay) through Blue Cross. This may be the only perk of teaching in a public high school!
Marian
[This message has been edited by mbroderick (edited 08 March 2005).]
Posted by Tincup (Member # 5829) on :
STOP...
Will post results as soon as I get a chance.
THANKS!
Posted by Aniek (Member # 5374) on :
Yes, with paying all of physical therapy.
No problem on other expenses or drugs.
Posted by TinaAStPierre (Member # 7120) on :
NO (YEAH ROHDE ISLAND!!!)
Posted by sunshine24 (Member # 6867) on :
i have kaiser and they wont even believe i have lyme. let alone pay for any outside tests, doc visits and meds.
Posted by HaplyCarlessdave (Member # 413) on :
I have discovered the hard way that, too often, ...'insurance'.... corpanies are crooks. They don't pay, then the hospitals sic ..'credit agencies'... on you and you are screwed. Hopefully, I will be able to sue, but so far the scumbags apparently think I won't get it together to do so. We'll see. DS
Posted by rainbow (Member # 2711) on :
Like sunshine24, I too, have HMO Kaiser. They never diagnosis lyme, so never treat. Have had to pay ALL treatments out of pocket. They refuse to consider Igenex's lab results.
Posted by Michelle M (Member # 7200) on :
So far so good. Have only been in treatment for two months. I have Blue Cross PPO and my LLMD is a Blue Cross provider. Also I'm on orals only so far, so haven't heard any flak from Blue Cross. My LLMD does tell me they'll only authorize ONE month of IV treatment so I guess he knows what he's talking about.
Michelle M
Posted by DJP (Member # 5893) on :
Yes, for out of state labs
Posted by no2lyme (Member # 6978) on :
Duh - I have lyme disease - of course I have had trouble. Blue Shield PPO only the worst of the worst.
6 pills at time - still fighting appeals for 18 months of IV, once the covered bicillin I had been on it 10 months and finished its course.
Oh the irony of insurance.
Posted by seibertneurolyme (Member # 6416) on :
No for hubby. He filed so many out of network claims the insurance company gave him his own personal claims processor. He is on the 3rd one now -- one he probably got fired and one was promoted. He also made a friend in the appeals dept. which has been a big help.
We have learned to call any new lab or doctor before tests or appointments and ask for info regarding codes etc. Hubby calls insurance with info and finds out what bottom line cost of test or office visit is beforehand. He sends tons of documentation to his designated claims processor and calls and harasses them if things don't get processed like we think they should be.
Of course the out of pocket costs are prohibitive (mostly paid at 70 % of reasonable and customary). We pretty much gave up on in network doctors although we try to use in network labs and hospitals for tests and procedures.
Most prescription nutritional supplements are not covered and annual prescription cap is $5000 which is not high enough even without IV antibiotics.
Bea Seibert
Posted by digirl02 (Member # 7177) on :
insurance pays about 1/16th of what i put out in cash and i am now broke
Posted by cawpo (Member # 5744) on :
yes
Cheryl
Posted by Neil M Martin (Member # 2357) on :
yes
Posted by Lishs mom (Member # 2344) on :
quote:Originally posted by Kira: [B]Initially there was an issue with IV abx till LLMD brought up the positive PCR...no problems since then...
B]
Kira, what ins. company are you with, mind if i ask?
Posted by caat (Member # 2321) on :
yes, definitely.
Posted by tykee (Member # 2285) on :
BCBS of South Carolina refuses to pay for PCR because it is "considered investigational"! To me a urine test is "investigational" I went to my llmd, "donated" my blood in November. I am still fighting BCBS of SC to pay the $1200 I am being billed.
NEW question: IF we refuse testing sre we going AMA (against medical advice)??????
