LymeNet Flash: Insurance Woes

This is topic Insurance Woes in forum General Support at LymeNet Flash.

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Posted by CharV (Member # 5849) on :

I just was told that my insurance company will not pay for the additional 4 weeks of IV therapy my Dr. has prescribed. The out of pocket cost is $200 per day, but I am still clearly having Lyme related symptoms.

Anyone have some good advice on how best to handle this and get the insurance company to pay?

Posted by Neil M Martin (Member # 2357) on :

CharV:

$200 seems high even for IV antibiotics.

Did your Insurance Dr. diagnose Lyme?What are you taking that costs so much?

I had to pay out of pocket, then file claims for what I paid.

In 1999 the HMO denied the claim. I appealed (following their appeals protocol)but I ran out of strength and had to walk away.

In 2002 I foled new claims. The HMO delayed in its reply for over a year. I got my Fed senator to talk with them, and they paid enough to cover my 1999-2002 oiut of pocket expenses.

Document everything. See my posts on this topic. Others have also posted good ideas for you on the subject.

Neil

[This message has been edited by Neil M Martin (edited 31 December 2004).]

Posted by tabbytamer (Member # 3159) on :

Hi CharV,

Don't know if this is still current info, but you may find some help here:

Click here for info on Free medicine programs

Posted by minoucat (Member # 5175) on :

Char -- our insurance refused to pay on several occasions. We kept fighting them on it, and they eventually did fork over, once, apparently, by accident. We went through an appeals process, sending in tons of documentation, doctor's letters stating the necessity of tx, medical abstracts, etc. etc., and assured them we'd go to court.

Each company's appeals process is different, so you'll need to find out what you need to do, and follow it to the letter.

This link has some helpful info for fighting with your insurance company. Some of the links relate to disability insurance, but some of them are about how to get your medication and treatment approved.
http://flash.lymenet.org/ubb/Forum1/HTML/030280.html

Bottom line: be prepared to go all the way, find out what your legal options are, and pull in all the big guns, from your insurance commissioner to your state senator. There are some suggestions on this post: http://flash.lymenet.org/ubb/Forum1/HTML/030256.html

Just as an afterthought -- although I've done IV abx extensively (rocephin and Doxy) and for long periods, I'm actually doing best now on IM bicillin, and on orals for coinfections.

It takes a while. Good luck.

[This message has been edited by minoucat (edited 02 January 2005).]