Already appealing BCBS policy of 28 day IV for lyme for exception.........
Now request for levaquin IV for bartonella is denied because "bartonella is lyme"
I don't have time to educate this case manager! Can she really be this dense? They don't have the same medical code number. Is this just a stall tactic?
No where on the BCBS policy of lyme treatment are co-infections mentioned. The only place bartonella is mentioned in the policy has to do with nucleic acid probe testing being considered investigational.
What next!
Got to go, baby crying!
MommaK
Posted by jamescase20 (Member # 14124) on :
Thats why I am not even bothering with insurance. Bought leva from india...I really dont even want my insurer to know about all this. Oh, I have private insurance...so they would play so many games...
Yes, there stalling...they do anything to avoid paying...even if not leg. they will play every game they can play.
Posted by MommaK (Member # 10376) on :
Any suggestions on what to put in insurance appeal letter?
How do they know she didn't get bart from a cat?
Waiting on Igenex bart lab results. I don't doubt clinical dx. Rash on thighs, enlarged pelvic lymph nodes. Is rash meaningful in dx like EM rash in lyme?
Do you even use levaquin on lyme?
Thanks, MommaK
Posted by clairenotes (Member # 10392) on :
I don't know if this will help, but can you provide them with some definitions of lyme disease? Here are three that I found relatively quickly on the internet and co-infections are no where to be found within the definition.
Bartonella henselae (formerly known as Rochalimaea henselae), a rod shaped gram negative bacteria, is neither equivalent nor exactly that of Borrelia burgdorferi, a corkscrew-shaped bacteria that is neither gram positive nor gram negative (but when stained, stains as a weak gram negative). They are completely two different bacteria.
Either they're stalling or that person needs to be reassigned!
Posted by tailz (Member # 10014) on :
Where are our doctors? - the ones who we were raised to entrust our lives with who are supposed to be protecting us?
We're dying of infection. I don't know why it didn't hit me before, but I have an autoimmune disease with low IgG 1 and 3 subclasses which will put me at risk for lymphoma, stomach cancer, colon cancer. My grandafather died of colon cancer. My grandmother died of Alzheimer's.
I know infection combined with chronic EMR exposure is the reason for my being immunodeficient, and not a damn doctor will listen to me.
Posted by bettyg (Member # 6147) on :
up for more replies! Posted by jamescase20 (Member # 14124) on :
I think most doctors have themselves in mind, rather then the sick pat.
Posted by MommaK (Member # 10376) on :
Hi!
Thanks for your replies.
The medical policy does have a decent defination of lyme disease. At least they aren't disputing the lyme diagnosis - yet.
Waiting on Igenex bart test results. Maybe a positive test will at least prove diagnosis of bart. Without a positive bart test wonder what will happen.
To quote a neurologist "The chance you have a rare infectious disease is very, very small. The chance you have two rare infectious diseases is basically imposible."
Guess there are many doctors that need educating, so I shouldn't be surprised the RN case manager at the insurance co does too!
Thanks, MommaK
Posted by D Bergy (Member # 9984) on :
Insurance companies teach their people to deny most any claim, for most any reason. Especially if it is expensive.
Appeal their decision. Tell them that they are separate organisms and require separate treatment and that it is not your responsibility to teach them about pathogens. If that does not work you may want to tell them that you are writing a letter to the the state insurance commissioner explaining your problem. (whether this scares them depends on what state you are in.) Unless your policy excludes this procedure, they have no grounds for denial.
You will find the next reason for denial is that the procedure is "experimental".
They count on wearing you down before they submit. Unfortunatly it often works.
Do not be afraid to write a letter to the insurance commissioner. Insurers do not like attention being focused on their denial policy.
BC/BS is paying for my Low Dose Naltrexone for Crohn's and my policy specifically says they do not pay for this drug. They also do not pay for compounded drugs. My LDN is compounded. Plus, its use for Crohn's Disease is experimental. They do not even know what they are not supposed to be paying for. My medication is cheap, so they do not even look into it.
Good Luck
D Bergy
Posted by luvdogs (Member # 9507) on :
I agree with the Insurance Commissioner idea! It worked for me from a different angle, and with United. But the minute they came in - or that I mentioned that I have been dealing with the Commissioner, all was settled.
And DO speak to the commissioner, That is what they are there for and they will help!
Best of luck to you and I am sorry for what you are going through.
Posted by Chia Pet (Member # 12399) on :
I would print out as much as possible about Bartonella as you can especially this article
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