I'm seeing an LLMD who's not a participating physician.

According to HealthNet's "rules" though, there is ZERO coverage for out-of-network drugs and lab tests.

This, however, seems a bit unfair and I'm suspecting that they often do not enforce it.

So to those of you who are/were HealthNet members; Has it been your experience that they [HealthNet] cover out-of-network prescriptions and lab tests?

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Originally posted by liz28:
Almost never. They have, however, faithfully paid for all my prescriptions, for months on end, without one complaint. I haven't added up the tally, but it's probably around $100k. That includes rocephin, which they covered for seven months, no questions asked.

It does seem like they may be weeding out Lyme doctors. But if you can get the fee together for an initial visit, many LLMDs will do phone consults with you instead of office visits. They aren't cheap--mine charges $95 for 15 minutes--but it sure beats $350-800.

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Did you mean to say that HealthNet faithfully paid for your in-network prescriptions and tests and that they almost never paid for any of your out-of-network prescriptions and tests?

Btw, in my experience, it's only the initial visit that is expensive.

I've seen two LLMDs in NY (Dr.C and Dr.L) and here's what they are charging:

LLMD Dr.C Dr.L
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1st visit $350 $750
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Second visit $150 $350
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>2 visit $150 $175
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In addition, both charge another $25 for blood work.

It is clear from these charges, that in the long term, the office visit charges are the least to worry about.

It should be notede that wrt to initial visit with Dr.L, I was there for THREE hours talking to HIM. He is extremely thorough and worth every penny, IMHO.

He also provides you with a 10p summary of his initial assessment of you, which you get at the second visit.

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Originally posted by daniella:
That seems outrageous! I have new insurance too and they don't cover my llmd. But they do cover his prescriptions and lab tests. Is it legal not to? Is that an hmo?

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HealthNet is an HMO.

I don't know for sure if it's legal or not.

But my guess is that it probaly IS legal, just not very nice.

I switched off the plan that pays out of network, because I couldn't meet the deductible--there was always some excuse why the payment wasn't covered.

It's great that the price goes down with subsequent visits, but right now, all those numbers are way out of my league.

Five days ago I went for a refill of Plaquenil.

Phamacist asked for my new insurance card. So I gave her my HealthNet card.

Apparantly they accepted, cause I only paid $10.

So I'm hoping this is the beginning of a beautiful relationship with HealthNet.

I'll keep you posted as I'm up for renewal of Amoxi and Mino soon with Dr.L. As well as another blood test to determine the level of Amox in my blood.

I'm gonna give it a go, just to see what happens, before I go off the deep end and switch LLMD.