I am brand new to the board, but have learned a lot by reading since I found out that after 15 years of a Chronic Fatigue diagnosis, it is really lyme. Proven by Bowen labs.
My doc told me I could start immediately on oral anti-biotics, but IV was really needed as I am in late stage lyme disease.
Two weeks into my daily treatments, I got a letter from Aetna saying everything is denied. Doc says she tried to fight them but lost.
I don't know what to do!!
Has anyone else been denied by Aetna? Should I get an Erisa literate lawyer to fight for me?
I'm sitting here crying as I was just laid off from my job last Wednesday. :cry:
[ 12. January 2006, 04:51 PM: Message edited by: tothepoorhouse ]
Posted by timaca (Member # 6911) on :
Go to "general support" and read my posts there on insurance appeals. I included a letter to my insurance company when they denied my IV. They eventually paid.
Insurance companies are counting on people giving up. 7 out of 10 do when they are denied a claim.
Don't give up. Get a copy of your policy. Read the letter they sent you, and in your letter to them address why they denied your claim (specifically) and refute those denials.
Good luck.
Posted by johnlyme1 (Member # 7343) on :
Timica is correct - I sent a couple of the forms to the angency that set up my IVs -
quote:Originally posted by timaca: Go to "general support" and read my posts there on insurance appeals. I included a letter to my insurance company when they denied my IV. They eventually paid.
Insurance companies are counting on people giving up. 7 out of 10 do when they are denied a claim.
Don't give up. Get a copy of your policy. Read the letter they sent you, and in your letter to them address why they denied your claim (specifically) and refute those denials.
Good luck.
Posted by karatelady (Member # 7854) on :
If you type in Aetna in the search menu above, you will get some feedback from others using Aetna and IV's.
Sandy
Posted by Lisa B. (Member # 8547) on :
Aetna did cover 2 months of IV Rocephin for my daughter, back in 2003. I don't know the specifics about how different plans work, but maybe it can prove a precedent?
Lisa
Posted by trails (Member # 1620) on :
Keep fighting! I think you have a chance! Use what others have posted and keep searching for more answers.
I had to fight for my second month of IV with Cigna, but eventually they gave it to me. Can you get a second opinion LLMD appoint? Sometimes having TWO docs helps this process.
Also remember you are IN TREATMENT, so you need to let them know that this is time sensitive appeal!
Bestest, Trails
Posted by tothepoorhouse (Member # 8595) on :
Just lost the last post I tried to put here. I guess I have to get used to this board.
I did call a lawyer who wants all of the documentation from Aetna, my insurance policy (which HR lags on getting to me) so I guess I'm going down a long road.
Dh says we can't win against big Aetna lawyers and I have no idea how much 6 weeks of antibiotics IV, along with saline and heperin.....along with visiting nurse will cost me out of pocket. Horizon Healthcare, who is sending me all of these injections, along with visiting nurse, ..........who I will eventually owe, don't return my calls.
Posted by hopeful4 (Member # 8486) on :
I'm sorry that you are going through this, it's really not fair!
I just want to encourage you to not give up. Try to follow the advice that folks have given you here, check on their suggestions.
I haven't had to fight anyone (so far) with my treatment for Lyme. However, I did put up a pretty darn good fight with my insurance co.
They denied me an expensive genetic test my doctor ordered when I was diagnosed with breast cancer. I needed the results to determine what surgery to have...a lumpectomy or two total mastectomies! I'd say that's a big deal.
They dragged their feet with delays, which delayed my cancer surgery. I was freaked out. But I fought, and WON. You can too!
Take good care, and I know all will work out for you. Hopeful4
Posted by Jillybean (Member # 8071) on :
I also have Aetna, and was just diagnosed a few months ago. I see LLMD for the 1st time Monday.
A month ago or so someone on this board posted Aetna's new Lyme guidelines, which I printed out for the doctor that was treating me. (I went to 2 other ducks before that).
From what I remember, it said you had to have positive western blot. My ELISA was positive from 1st duck, put me on doxy for 2 months, saw 2nd duck, ran W.B (thru Quest), and came back negative.
In the meantime I was also sent to have an MRI, the hospital sent me a copy of the bill ($6,400.00. YIKES!!!!), and I have been fearful of a denial letter, but nothing yet. And from what I understand, as alot of my symptoms are neuro, I will probably need I.V's......I'm so scared they won't pay for it, and I sure don't have the $$$$.
I wish you great luck, fight those big guns, and do a search above for Aetna, and read their new guidelines for Lyme coverage.
Jill
Posted by vitch (Member # 8094) on :
How many of you have written to your senators and congressmen asking for a law that guarantees long term treatment for Lyme Disease?
Posted by char (Member # 8315) on :
Aetna paid for 6wks for my son.
They had said they would pay for 4wks, but did pay for 6wks. Got ID dr to write an explanation. My dear husband had to hound him and esp insurance company.
We did end up paying out of pocket for 5 more wks but don't regret it.
I think you can get more than 2wks out of them.
It is hard to keep fighting when reason you are on IV is that you are sick and fatigued!
Best Wishes,
Posted by liz28 (Member # 4946) on :
Even though this is a stopgap measure, I wanted to offer which antibiotics worked for me. These were actually more powerful than IV rocephin, which I took for seven months with little change, and made the insurance company happier, if such a thing is possible.
Fair warning, though: these antibiotics will all cause a massive, overwhelming herx reaction, and require lots of liver support to keep your liver enzyme levels from going through the roof. If you can stick with them, however (and there is little chance of being able to work at a job at first) these should get you functional in three months. If there is a way to make sure you have someone in the house with you or checking in with you, and that you have enough food and water in the house for at least two weeks, it's a great idea to plan in advance.
Also, I had to take an anti-inflammatory. If you feel uncomfortable with a prescription like Celebrex, you can check out vitamin store supplements like bromelain or theanine.
Omnicef 300mg/2x day Ketek 400mg/2x day
Wait one month for herx to calm down, then,
Flagyl pulse four days a week for 1-2 months.
Also, if you stay on IV rocephin, you must take Actigall, a prescription medication, to hang on to your gall bladder, mega probiotics, and a prescription to control yeast, such as nystatin or diflucan.
There are many, many supplements you can take, but everyone has their personal favorites. If you look through Dr. B's 2005 treatment guidelines, he has many excellent suggestions.
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Just lost the last post I tried to put here. I guess I have to get used to this board. ![[Mad]](mad.gif)
Horizon Healthcare, who is sending me all of these injections, along with visiting nurse, ..........who I will eventually owe, don't return my calls.