for out-of-network doctor? Is this possible? Would this just cause a red flag?
If BC/BS asks for diagnosis, what do I say?
Anyone have any luck with this? The only reason I am considering is because my in network maximum out-of-pocket is $1500 (almost met) and out-of-network max is $3000.
Posted by janice victorov (Member # 22937) on :
Jennie, I tried that with BCBS. They will pay 70% percent of an office visit for similiar doctors in that area.
That's 70% of what they think the office visit should be. I saw an llmd out of network for about 6 months. I sent them all my receipts with diagnosis codes. I believe I got something like 469 back out of a 2000g bill overall from the same doctor.
Even though BCBS is one of the beter ones,,,they still reimburse not as much as you pay out of pocket.
Posted by blinkie (Member # 14470) on :
This was suggested to me but I think the Dr has to go for it. Not sure though.
When I told the rep that suggested it m yDR would never sign up with them, she dropped it.
Posted by lymednva (Member # 9098) on :
Most LLMD's do not take insurance, to avoid closer scrutiny about what they are doing.
Mine takes Medicare, for patients who were his patients when they became eligible, and now files my secondary BC/BS.
Since I do not have a positive Lyme test he includes dx codes for things like chronic fatigue, etc., that cover what I am dealing with, without the Lyme jumping out at them.
It has helped immensely. I also have very low deductibles.
Posted by lou (Member # 81) on :
No, the doctor has to be a preferred provider, and very few lyme docs will sign a contract with insurance companies. And the insurance companies don't want them anyway. Several lyme docs had their contracts terminated because it was costing the ins co more than they wanted to pay.
So, consider yourself lucky if your ins co will pay out of network for your doc visits. It will be less, but it will be something.
Posted by springshowers (Member # 19863) on :
BCBS has not denied my doctor who is in networks billing and charges using the lyme diagnostic code. No questions asked.
My doctor told me when I asked that it is based on medical necessity and that I should not worry.
And it did work out fine
Posted by Keebler (Member # 12673) on :
- This could vary state to state - or by insurance region. If a state is an "anti-lyme" state, it may be more difficult. -
Posted by cjfrank (Member # 26985) on :
I recently spoke to a rep at BCBS about my Lyme.
I work for BCBS and received a verbal reprimand for calling out sick. Next is written and then out the door.
I requested the paperwork for FMLA and it was faxed to me.
I took it to my doctor to complete, the reasoning was "serious health condition".
My doctor who is not an LLMD completed the paperwork after telephoning me as to just what I thought that I needed for time off.
I was very pleased to see the paperwork was approved. So I am now covered for the next time that I go down and will not be losing my job.
The woman I spoke with at BCBS was very sympathetic to my situation and even told me that she had received a similar call like mine earlier in the week.
I do not know if the paperwork would have been approved if the condition said Lyme, but because it said serious health condition the request for FMLA was approved.
I hope that I will not have to use it as I have been feeling better.
Nice to know it is there just in case I go down again.