LymeNet Flash: Help With How To Word 'authorization' for insurance Co --HELP!

This is topic Help With How To Word 'authorization' for insurance Co --HELP! in forum Medical Questions at LymeNet Flash.

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Posted by KauaiGoddess (Member # 11782) on :

Aloha,

I just got off the phone after being SCOLDED by

my insurance co for not following procedure....

My PCP doc (who prescribes my LLMD meds) has

always told me that my insurance co wouldn't

cover out of state doctors and she wouldn't

waste her time trying...even as much as I kept asking her to try....

I have talked with my insurance co many

times...just sent them bills from IGeneX and Dr.

H, in hopes of getting re-embursed...

But there was no Authorization from my PCP...and

the lady was PIST at ME!!!!!! This caused an

emotional overwhleming helpless feeling in me...

I need help... !!!!!!I know almost everyone has

struggled with their insurance co & PCP's ..can

you give me advice?

I'm going to see my PCP tomorrow to try and

convince her that this could work and be worth a try...

I'm going to type the letter for her, and offer

it, so it's less work for her...

But what key points do I need to make...any advice...???

The Insurance Co. said I have to use ALL

avaliable resources IN STATE..she was thinking

of an infecticous Disease Specialst...I've been

that route...LYME IS HARDLY SEEN IN

HAWAII...THEY REALLY DONT KNOW A THING except

the page description in a classic med school

book...that's why it

took me 2 years for ME to find this .....even

on the mainland, it's the same deal with these

docs....

here's my thougths on points I should make:

-there's no docotor in Hawaii that Specializes in Lyme and co-infections

-there are infectious disease specialist that have heard of Lyme, but don't have the expierence like a Lyme Literate Doctor does

-My PCP highly recommends that I see Dr. H in *** to further treat this Disease and its co-infections

what else ???please help!!!!I know it's all about the wording...

mahalos~...fawne

I 'm aware I'm VERY lucky that my meds are covered....so so so so THANKFUL!!but I can't work and my parents can hardly afford to keep paying for ALL my Lyme needs.... [Frown]

what else can I do?

Posted by Aniek (Member # 5374) on :

I suggest using the term "medically necessary" because that has a lot of pull with insurance companies.

Something along the lines of "I, Dr. PCP, have determined it is medically necessary that patient receive medical care from a physician specializing in Lyme Disease. The physician needs to have extensive experience treating patients with complex cases of Lyme Disease. As there are no such physicians located within the state of Hawaii, it is necessary that patient see a doctor out of state. I have recommended the care of Dr. H in state to provide this treatment."