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I have yet to lose a battle and I am really not worried, but I just about lost it tonight when I was talking to a claims adjuster, mind you had already got approval for IV treatment for 90 days which included a medical review, now when the bills are coming through they are getting flagged for medical review again. Which is absolutly insane.
But the reason why I lost it was, she said to me in response to my question as to why this would go to medical review for a second time was, "why would a doctor order IV medication for a little bug bite." This just about sums it up for me I tell you. I think she new alomst immediatly she said the wrong thing, but she decalred war.
What United is doing is really looking at the diagnosis code. If that code is not listed under the procedure it will get bumped. All of a sudden now, my labs are getting denied left and right. They tell me it is the AMA guidlines that are being used. I dont know if this is a recent trend or not, since I am new to United, but I am now having my doctors list all incremental diagnosis.
[This message has been edited by hwlatin (edited 25 April 2005).]
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The Lyme Disease tests miss 99% of Lyme. Any MD who believes in the tests is not Lyme Literate and should be avoided at all costs.
In the midst of a battle with one of our insurance carriers I read John Grisham's "The Rainmaker". I would never have thought the book was remotely plausible had I not been living through a similar scenario. I credit the book with some of the furious energy that kept me going. We did finally get our medical bills covered, but it took a lot of work, time, and the inexhaustible patience and goodwill of our pharmacist.
Best of luck, hw. If this had to happen, I'm glad it's now, when you seem to be doing better and can deal with it effectively.
quote:
Originally posted by hwlatin:
"why would a doctor order IV medication for a little bug bite."
What in the world did you say to that? I would have come screaming through the phone, I think....and I'm pretty mild-mannered!!
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brainless.....where did you get the figure of 99%?? I know it's bad, but....
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oops!
Lymetutu
If you look on the supper bill from the doctor there are alot of diagnosis mostly specific to the doctors specialty. Most LLMD's put down Lyme, and also include babs, bart, etc.
I now make sure that they also list Gastroparesis, ADD/ADHD, CFIDS, FM and anything else that I am suffering from, this will insure that when they arder tests that they will get covered, at least from United Healthcare's perspective. If they only list Lyme, since the AMA does not associate alot of complications other than arthritis, the tests would get bumped.
Lymetoo,
I almost did lose it, in a deliberate low voice I said to her, "dont you ever tell me that this is just some small bug bite. I nearly died and spent 4 months receiving plasma exchange because of TTP after a three hour seizure and a week long coma, because of one little bug bite. Nearly died twice more from staph infections because of one little bug bite, and have spent the last 5 years in pain and agony, not to mention my two sons that are both positive and have been doubled over in pain and can barly function in school because of one little bug bite. Over 1.5 million dollars has ben spent on my families care because of one little bug bite, My career has been destroyed because of one little bug bite, my marriage ended because of one little bug bite, and the reason why it has gotten so bad is because of people like you that think all it is, is little bug bite."
This lady picked the wrong persone to say it to.
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oops!
Lymetutu
On another note....united is really rotten!
We had them for coverage before Mega..who by the way has been wonderful....
Back when we had united..called useless by me, I wasn't even known to be "sick", and we had to fight then to pay anything....
I used to have to quote the policy to claims adjusters on a regular basis and I knew supervisors by name.
I'm sorry you are having to deal with them.
I'm sorry about your new insurance.
That stupid "be-a-ouch"!!! I feel so mad for you. I would beat her with her own phone. Someone that ignorant shouldn't be dealing with the public.
Also I just do not see how the insurance companies dictate our health care when they are not health care professionals.
How does someone go to that job day after day. Do any of them have a conscience?
I really liked your reply. Did she apolagize?
Go get em'!
Heather
I just wish all of this effort would yield results for others, unfortuanatly my situation is unique in a sense that I have people with power behind me that really care and can make things happen. I wish that was the case for everyone.
Thats what I would like to do. 
Some day the real story on this illness will come out. Have faith.
Pam
I know the truth will one day come out. But this disease is far beyond a tic bite. Was intersting on Scrubs last night Lyme Carditis was mentioned, Dr. Cox took the fact that the man was camping prior to the onset. It was used in a comic way. Lately there has been alot of mention about Lyme in TV shows, but the truth is slanted, I wonder if this is intentional or not.
If someone had Lyme that was on the production team, I can't imagine that they would allow this slant.
Same with the labs. I know for a fact that Quest gets at least some of its "lab tech's" just from part time employment agencies. I know of several cases where the people are receptionists, ect. who do the lab work.
Now I am once again getting scre**d by those doctors that did it to me in the first place because they and ones like them are setting the AMA guidelines that are now allowing the Insurance Companies to refuse treatment.
I now realize in addition to the CDC and NIH we need to go after the AMA.
Cave,
Yeah I saw that info. In my case United is just managing, the company I work for is self-insured.
I'm in the medical insurance field and I hate United Health. They bite the big one!
There are so many illiterate people when it comes to lyme. For example the school nurse can't figure out why after 4 months of treatment my daughter still misses school.
I told her to call my doc and she didn't...I wonder why?
One last thing you are right the insurance companies scrutinize coding and I know all the right codes to use for that worth less insurance co. You have to play the game. You could always threaten the insurance commisssioner and file a complaint.
Depending on what state you live in will determine how much they'll go after them and you will really have to keep on top of them. I know it's really hard when you have lyme to want another battle...jsut what you need.
Take care!
My first dr visit within 10 days of onset of illness, with a PCP who had only seen me one time, said I think it's lyme disease. He put me on abx immediately, and different combos at one time for several weeks. Chronic from the beginning. Since that time:
Dr C
Naturopath & rife machine
Muscle tester chiro dr
I'm making real progress now. I had to go on my own and find my way to healing. The system wasn't going to help me.
Take care,
Pam
[This message has been edited by map1131 (edited 28 April 2005).]