My wife had a very suspicious mark on her back and was not feeling well. doctor advised her to get tested for lyme. labcorp did the test (Lyme (B. burgdorferi) PCR). Now insurace Aetna is saying it's not fda approved etc... not medically necessary so they wont' cover.
what if anything can we do to either: 1) convince aetna that her symptoms should have been tested given a regular doctor in network she always goes to determined it's the best way to go forward?
2) (if aetna does not pay) convince / negotiate with labcorp to lower the test fee which is $590
Has anyone been successful at appealing to their insurance company that test was necessary?
Posted by Lymetoo (Member # 743) on :
I wonder why they chose to do the PCR right off the bat?
You can ask your doctor to make an appeal to the ins company. Keep after them. They MAY pay for it.
I got my company to pay for the Western Blot through Igenex many years ago, but it took 9 months of hounding them.
Posted by Donna Campbell (Member # 52157) on :
I had been successfully at appealing to my insurance company that the test was necessary. When I read or hear such stories like your one, I get annoyed. It drives me nuts when I hear about such situations. If your wife has a health insurance, then they must cover such a test. This is my opinion, but I think it is also fair. I have a health insurance from an awesome company which I don't want to present here, but I can recommend you a site that I checked before deciding what health insurance to buy, so if you are interested, you can access the site I am talking about by clicking on comparehealthinsurance.online. Stay safe and have a great day!
[ 02-03-2021, 10:26 AM: Message edited by: Donna Campbell ]
Posted by Bartenderbonnie (Member # 49177) on :
Time is of the essence in treating Lyme disease. Diagnosising and treating immediately = cure. Delayed diagnosis and treatment = chronic long-term disability. WRITE THIS IN YOUR APPEAL!
Most insurance companies bank money that patients won't appeal. And most patients that appeal receive a favorable judgement.
Also, your insurance company, Aetna, recently settled a HUGE class-action filed by Lyme patients for medical bias, conspiracy, collusion and standard medical care of Tick Borne Infections.