posted
I just need to know if anyone knows anything else I can do. I'm on IV meds right now and before I started them we contacted Blue Cross to see if they would be covered.
She said yes and that it didn't need precertification. I got the picc line which they paid 80% but then after I start the meds I get a letter saying they wouldn't cover it.
So here I am with 2 weeks worth here and then they won't pay. I had my LLMD to appeal for me and they denied it. I need to know if there is any thing else I can do to turn this around.
So here I am now owing for 30 days worth. I wanted to give the IV meds longer but now will be taking the picc line out next week. I still have 5 days left to take. I've had to stop twice because of elevated liver enzymes so maybe it's not the best for me anyway.
Hubby will do whatever he can to get this covered. If anyone has any suggestions I would appreciate it.
Sapphire101
Posts: 495 | From KY USA | Registered: Dec 2004
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bettyg
Unregistered
posted
APPEAL this using their procedure in their booklet.
Also, ALWAYS keep notes of the date, time, and PERSON you talked to PLUS what they told you word for word! Slow them down so you can write it all down.
Iowa's Wellmark BC/BS covers for 30 days according to the brochure I have. I've NOT used IV...but that's what it states.
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posted
Thanks Betty but the reason they won't cover it is because they had me get the stupid Elisa test and of course, it was negative. This is what they based it on. I guess they don't accept Igenex results. Mine was positive.
Sapphire101
Posts: 495 | From KY USA | Registered: Dec 2004
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just don
Frequent Contributor (1K+ posts)
Member # 1129
posted
Hi Saphire, Insurance companies have really learned how to PLAY the game so they dont have as much to pay. They are experts at avoiding at all costs the expense of getting us well. They use anything they can to do so as you are finding out.
Even IF you could find that person that said it was covered they would say upon review the made an error and they are not reponsible for errors and the real policy says"Blah, blah blah".
And their excuse for doing it is they say it is their responsibility to keep the claims low so it keeps the 'group' doesnt have high premiums.
Dont know about yours, but my premiums are sky high and still no coverage. GRRRRRRR, but thats about all you can do about it!!.
There are appeals you can do all the way up the chain. You should try it because it only takes one time to unload the burden of the last 30 days of IV's which is considerable I am sure.
Probably 10K or best part thereof, by the time you add this and that and a bandaid or two in there.
same thing sorta for me. they covered the groshong central line, BUT doing that put ME into another category of "Managed Care" Thats whose job it is to cut you off and get you gone, no matter what!!
I read a first person account of a lady Dr. whose job it was to deny people treatment, no matter what the reason, for a monetary bonus, and accolades from the insurance company.
She got a real nice bonus if the patient died!! No joke. So it is hard to fight that kind of system!!
In my opinion, thats who is feeding Camp "A". For enough ammo to deny or contradict any sustained treatment!!
Any body have any ideas how to blow there cover, or flush them out of hiding regarding the real money trail??
Hope you find the way Saphire, have you checked into needy meds free programs for YOUR IV med???
Wish I had met you at the float, missed it, darn!! Admire the story I read here about YOU,you have come a long way!!! keep up the great work!! cause I am --just don--
-------------------- just don Posts: 4548 | From Middle of midwest | Registered: May 2001
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posted
Thanks so much Don for your kind words. I need them right now. I am so sick and I just want to give up. I've been off the meds since Thursday and I've gotten a little worse each day.
Today I can't even get out of bed without having tachycardia. I have no energy whatsoever. I just don't know if I have much fight left in me. I'm just so tired of fighting. I guess the ins. co. wins.
Sapphire101
Posts: 495 | From KY USA | Registered: Dec 2004
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trails
Frequent Contributor (1K+ posts)
Member # 1620
posted
wait---through WHOM do you get your insurance? You said Blue Cross, but who is the employer? IS it a self funded plan? Reason I ask is that there ARE some people in this system that do really care and will actually get you what you need. YOu have to know WHO you are looking for. You have to get through the first few layers of people and begin a relationship with an appeals specialist at Blue Cross or your employer.
Sometimes calling the employer HR and talking with them about how the insurance co is denying this MUCH needed treatment is enough to get you into the top ranks of folks that will be the ones to make decsions and make change for you.
For instance--in my case: my insurer was BCBS of New Mexico. It was a self funded plan and my employer paid BCBS to administer the plan. So it was actually the employer that made the decisions about what is covered and what is not--especially in strange situations and not "norm" circumstances...like Lyme IV treatment.
The employer was the school district but the plan was governed by THE NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY.
Long story short: the deputy director is now working with me to get almost $10,000 of costs I paid for out of network surgery. The surgery date was august 2005...so this is 8 months later.
I appealed and squeeked and created such a paper load that BCBS ended up losing half my file and freaked out when I won a less expensive case I had brought to the attorney general. (this was for $70 that an ambulance co was wrongfully billing me for) I never once used a lawyer or paid for anything except my fax machine (which I LOVE) and paper and phone calls.
They realised I knew my bussiness and that I wasnt going to back down and that it would cost MORE in legal fees than it would to pay for my $10,000.
I havent gotten the check yet, but negotiations are under way. The deputy director now calls ME once a week to let me know how far they got and what the next step is.
You have to scratch your way to the top. The people who do not have any power will not allow your appeal to go thru and will not allow you to get what you need.
You might not fight right now---you may want to save your energy. But if I was You....I would document EVERYTHING right now, and begin an appeals process and call them every single day. every single day. Harrass them. It works. It might take months, but when they realise you wont go away, and your lyme wont go away either....then they might pay.
I just started a file and made sure I had time to call for about 30 minutes a day.
You said your hubby might be able to help? FIrst thing: get the insurance issue of the LYME TIMES and read it. and really understand it---it could really help you get thru this.
This is long, I am sorry. I think you can fight this b/c kentucky is not yet as hostile as places like CA---you might be able to get this thru!
I hope it helps you. take good care now, Trails
Posts: 1950 | From New Mexico | Registered: Sep 2001
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just don
Frequent Contributor (1K+ posts)
Member # 1129
posted
Sapphire, IF you have survived everything I read that you survived, you can survive this too!!!
Trails has the excellent response, as usual. Read it, then read it again, then do it step by step, and be persistant!! Get to be the burr under their saddle!! Make them think they won, after they pay they wont have to take your calls any more!!
Turn up the heat,,, burn them out of their position,,, win at all costs!!! I am waiting to hear the results you desire. Until then call me --just don--
-------------------- just don Posts: 4548 | From Middle of midwest | Registered: May 2001
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posted
you can use the appeal process throught BC/BS patient booklet, you have first, second, and teriatary appeals. Call your state board of insurance and I would also contact if there is a health reporter at your local, yet, nationally affiliated tv channels to get your story on. It has worked in the pHiladelphia market where people have gotten the shaft from insurance. Go to your local newspaper. The squeaky wheel gets the oil. Also call the drug company to see if you qualify for anything. Leave no stone unturned. Stay strong!!!
Posts: 719 | From Delaware | Registered: Jan 2006
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bettyg
Unregistered
posted
breaking this up for us neuro lymies...
quote:Originally posted by iceskater:
you can use the appeal process throught BC/BS patient booklet, you have first, second, and teriatary appeals.
Call your state board of insurance and
I would also contact if there is a health reporter at your local, yet, nationally affiliated tv channels to get your story on. It has worked in the pHiladelphia market where people have gotten the shaft from insurance.
Go to your local newspaper. The squeaky wheel gets the oil.
Also call the drug company to see if you qualify for anything. Leave no stone unturned. Stay strong!
Iceskater and trails, excellent advise! Bettyg
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timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
do a search on insurance appeals here at lymenet. It should bring up a letter that I wrote to my insurance company...maybe it will help you.
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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