Blue shield (HMO)

Kaiser Permanente (HMO)

BCBS (PPO) But....they only pay 80% of IN-network doctor care and IV therapy and hospitalizations!!!!!

BCBS (PPO) same as above but is more in monthly premium and pays 90% of IN-network.

I used to only have co-pays, now I am looking at footing large bills when I go on IV or get hospitalized.

Any opinions, particularly from CA residents?
Thanks,
Trails

On the whole, Kaiser in CA is VERY resistent to treating Lyme, though a few have been able to pull it off.

The more flexibility a plan allows, the more you will be able to get covered, even if it is only a percentage. BTW, BCBS is pretty well known for only covering 30 days of IV in CA.

Some folks may have tips for how to get around it, but that is the basic line they hold. I know that it varies according to the exact plan you have.

I know this isn't good news. Once you get your plan, people can help with how to leverage the best coverage of things. be sure to look over CALDAs website and the Insurance Issue of the Lyme Times for some good strategies.

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Sonoma County Lyme Support
[email protected]
 

Although, after many appeals and long letters from the lawyers I am employed by, I have been able to beat some sense into them.

Actually, Blue Shield - Blue Cross anything Blue is very well known for their poor coverage of lyme.

I know Kaiser is as well but that at some Kaiser's you can get them to cover it. Bay Area members of Kaiser have had some victory.

Pretty much, they all are evil.
 

But not the news I want to hear for SURE. I have BCBS now and have NOOOOO problemos for getting coverage for lyme treatment. My script insurance is not BCBS and so sometimes they are hard to get around, but on the whole BCBS here in NM just foots all the bills. (shhhhhh) And there are A LOT of them. I currently pay co-pays for services and to think about paying 20% of a hospital stay or IV therapy is completely undoable.

30 days of IV even with a doctor's script?

I am really trying to figure out what the best thing for me is---I have to have endometriosis surgery in the next 2 months, and then start lyme treatment again and also serious endo injectable meds. How could ANYONE afford to pay 20% of a few surgeries and a few long term ABX runs?

Seems like the HMO is the best way to go since BCBS only pays 50% of non provider anyways, and we all know that they will end up paying something like 5 dollars to every one hundred I put out.

The HMO has resonable rates and no co-pays on IV treatment and hospitalizations. I guess it means getting your doc to script it? Do you think a kaiser or blue shield MD would listen to and take treatment plan suggestions from a LLMD?

I will be out in the northern San Jaoquin Valley, just south of Modesto, if that helps anyone answer any of my questions.
Thanks again!
Trails