Do insurance companies like Blue Cross, Humana, Aetna, etc. pay for blood tests for all tickborne diseases?
[ 30. August 2007, 12:15 PM: Message edited by: Jodi ]
Posted by bettyg (Member # 6147) on :
jodi, mine was paid 100% for by medicare since i'm disabled.
1st time, 3 yrs. ago, bcbs paid $35 - $45 since they were OUT OF NETWORK!
Posted by stella marie (Member # 7216) on :
My insurance BC/BS, paid for all labs except IGenex testing.
Posted by TerryK (Member # 8552) on :
Depends on your policy and the lab that is used. The first IgeneX test I had done was paid for by BCBS. The next IgeneX a few years later was paid for by Medicare. The best way to know for sure is to call your insurance company and ask if it will be paid for.
I've had labs at MDL that were paid for by medicare and other lab tests from several other labs that were not covered because the tests are generally not covered by most insurance companies but they are experimental tests. You will want to check each one if you need to make decisions about which tests to have done based on what is covered by insurance. Terry
Posted by Lymetoo (Member # 743) on :
Aetna paid for my WB's at Igenex. It took me about 8 months to get them to reimburse me though!!
Posted by Aniek (Member # 5374) on :
Blue Cross is a state based organization. So even if there is a corporate policy, it will vary between states with BC/BS.
But in general, it does depend on your plan. Some plans only cover blood draws from labs in network. Some cover less if it is out of network, but still cover. Some cover all labs.
In addition, some plans limit the total amount they pay for lab benefits, or pay diagnostic benefits which include lab, x-rays, and other radiology.
As far as the actual test for TBDs, I have never heard of a plan denying to cover a test because it tested for a specific disease. Unless the only lab coverage is for preventive medicine, in which case it will only cover things like cholesterol.
If you have an insurance plan now, you can call and ask. Ideally, you can send them your lab request from the doctor with the diagnostic codes, and they can tell you if it will be covered.
If you are looking to by an insurance plan, then look at the details of the plan.
Ask them if they can send you a SPD (Summary Plan Description) before you sign up. They have to send that to every enrollee, and it has details of the plan. I'm not sure if they will send it to potential enrollees, but you can ask.
Ask specifically about any limits on lab tests. Are there dollar limits? Do you need to have labs done in network? What is the coverage for out of network labs? What is the list of current in network labs?
Also be aware that any coverage you buy on the indvidual market will exclude pre-existing conditions. Find out exactly what that exclusion is. If you were infected before you bought the coverage, then it is a pre-existing condition. Insurance companies will claim it is pre-existing even if you didn't know you were infected.
Of course, since they don't recognize chronic lyme, there is a good chance they won't argue Lyme and other TBD's were pre-existing. But they might consider your treatment experimental if it exceeds IDSA guidelines.
Posted by perplexed (Member # 1913) on :
A Medicare Supplement will only pay what Medicare does not cover. Medicare pays 80% and then Medicare Supplement will pay 20% only if Medicare pays the 80%. These supplements are expensive and you have to read what they actually cover.
Right now in the USA Health Insurance is a mess!! Having Lyme Disease while our politicians are trying to figure it out is nasty stuff.
Medicare does cover Igenex testing. I called them, and it is on their website.
Hugs, Perplexed
Hugs, Perplexed
Posted by Aniek (Member # 5374) on :
Cave,
There may be a predetermination procedure available, but it probably needs to be in writing to be guaranteed.
Of course, their is never any full guarantee by insurance companies. When they drop LLMDs from their networks, they sometimes go back and demand repayment for claims they paid going multiple years back.
I really wish our politicians would wake up and realize that health care reform does not mean giving more power to the insurance companies.
Posted by Jodi (Member # 13052) on :
Thanks for your help! i really appreciate it!
Posted by on :
![[confused]](graemlins/confused.gif)