It is time to choose health insurance for the coming fiscal year.
I have always had an HMO, which has not covered my LLMD visits.
I am now thinking of a PPO. The info sheet states that after the patient's coinsurance and a deductible, they will pay in full up to a reasonable charge for covered services.
The patient may also be responsible for paying any difference between what the plan covers and what an out-of network provider charges for a service.
Since LLMDs are so expensive, I am wondering if the PPO will refuse to pay the usual percentage for a visit and will pay a much smaller percentage based on the fact that the fee is "unreasonable" or pay nothing at all as the plan may not cover chronic lyme treatment.
Has anyone had experience with PPOs and LLMDs? I know that I would submit the bills to the insurance company as the LLMDs don't deal with insurance companies.
Posted by TF (Member # 14183) on :
Yes, I had a PPO when I was treating lyme. Probably the largest PPO in the nation.
The PPO will have an amount that they consider reasonable for each lyme doc visit. They will pay their part of that "reasonable" amount, and you will be responsible for the rest.
So, it likely will depend on your lyme doc's credentials how much they will pay. If he is a GP or an internist, they will likely allow a lesser amount for each visit that if he is some type of specialist (which is the less likely alternative).
My PPO paid with no problem. They didn't deny payment because the diagnosis was lyme. They paid a small amount of each visit, and they covered the meds like they would for any other disease.
They covered Igenex tests and all other tests as they would for any other disease. What they allowed for Igenex was a low amount. I think they reimbursed me for about 1/3 of my costs there.
I submitted bills for 13 months. Before that, I went to lyme docs who took insurance. That was another 2 years of insurance reimbursement.