richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
Why do so many docs not take insurance? I thought it all had to do with some research trial that showed patients only need 3 months treatment tops or less and if they do not get well, stop treatment. The bacteria tends to be long life so treatment needs to be longer in most cases.
Is that why insurance will only treat with a positive test and only for a total of a month or two? Is this why the docs avoid insurance?
Then why do some take insurance and how do they treat differently? I am so confused on that subject!
Thanks for the help.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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Because of the testing criterias that have to be met per CDC guidelines.
Because of IDSA treatment guidelines and stance on this disease and insistance that chronic lyme does not exist.
Because if these drs take insurance and treat they will loose insurance rights because they are not treating per the guidelines AND they could loose their license to practice medicine.
Because the health industry is highly afraid of long term treatments with antibiotics because of antibiotic resistance (my opinion more here)
Because the insurance companies are happy to deny any claims and to have backing by the IDSA to do so they are loving it
The only hope we have right now is the new panel that will be reviewing these guidelines through the IDSA because of the anti trust settlement reached through AG Blumenthals investigation.
If the data is provided and presented appropriatley on scientific basis there should be some real changes come out in the treatment guidelines thus opening up treatment and insurance reimbursements for treatment.
Also opening up the opportunity for mainstream clinical diagnosis to be realistic.
If the HR 741 comes into play there will be funding avialable for more accurate diagnositc testing methods and potential research to help find more solid answers in protocols.
At some point the reality that this is the most prevalant verctor bourne disease in this nation and others as well, must come to fruition.
In my opinion it needs to change all the way up to the CDC and in reporting ways. It needs to be changed from a Human Health Awareness to a Public Health Awareness system.
The community needs to know the true risks and the medical community needs to know the true risks.
it is a loaded question with no easy answer and it will take all levels from political to medical to community to get this changed....
shewwwwwwwwwwwwwwwwww
I feel better!!!!!
-------------------- Seeking renewed health & vitality. --------------------------------- Do not take anything I say as medical advice - I am NOT a dr! Posts: 830 | From TN | Registered: Aug 2007
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daise
Unregistered
posted
Hi richedie,
The IDSA said first, 10 days of treatment--tops! Then 2 weeks, then 3 and now they are holding steady at 4. Quack! Quack Quack!
IDSA is all about profits over patients. It's about conflicts of interest and follow the money!
You'll learn all about it in the Activism Forum.
A great many insurance companies won't pay for an LLMD or treatment--even when you pay for your own test and it's positive. That's because the IDSA says chronic Lyme does not exist.
Some insurance companies do pay for meds and an LLMD--yet it seems usually with a lot of fighting. Most insurance companies don't want an LLMD on their list of network doctors because they want to ignore us.
That way they don't have to pay. But of course, that is stupid for their bottom line! They get away with it because they can hide behind IDSA.
LLMD's are in danger of losing their license to practice, by state medical boards. That's common. Basically, LLMD's need to fly under the radar. We're fortunate to have them.
I'm not going to ask you: Does that make more sense? Because it is not humane.
Insurance companies will have different arangements. Maybe you have to pay for your LLMD visits, but your insurance might pay for your meds.
Maybe they'll pay for consultation visits with an LLMD, but the prescribing of meds from a written consultation and your care will be by your PCP or other doctor, or for kids, some few pediatricians.
Many with Lyme are left to pay for an LLMD and treatment on their own. Or they can't work and can not pay for treatment.
It's very sad. It's not unusual for a Lyme patient to treat themselves. They find out places on the web where they can get antibiotics without a prescription, or they go to Mexico or finagle it from a veterinary supply.
There are a lot of desperate Lyme people.
Really--run over to the Activism forum and get involved. It makes me feel a lot better, when I'm involved in the good fight for recognition of chronic Lyme!
We need many more calls made to Pallone's offices. He's a representative in the House and is chairman of the committee where our bill is STCK and HE IS RESPONSIBLE for sitting on our Lyme bill 741.
richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
I am confused then because I know Lyme patients who will only go to docs who take insurance and say they treeat Lyme well....but, like you have always hard differently!
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
there arent any LLMD that i have heard of that take insurance. Some ID dr do take it and if you luck out will treat if you have a positive test.
My PCP at my first visit said I had lyme, just hearing two symptoms, but wont touch it without a positive test. He said he would have put me on IV doxy right away.
from what i understand insurance companies dictate what labs the dr use and how many tests they can do. Lets say a PCP is ordering too many thyroid panels, the insurance company can say look you are doing too many , cut back or your axed.
One dr I saw during my lyme journey said he could only use quest for Aetna. Use quest or else and this was years before Aetna went solely with Quest as their participating lab.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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posted
LLMDs do not take insurance. If you have heard that some do, maybe they are not LLMDs, but just doctors who treat lyme.
I have gone to a few drs, infectious disease and rheumatologist who say they treat lyme when you call them. what they mean is they treat according to IDSA guidelines (only with CDC positive test and only with 4 weeks of doxy)
LLMDs treat with ILADs guidelines, diagnose by symptoms and treat until 2 months after symptoms subside.
If you have an HMO, I think those plans only pay for in-network doctors. I have a PPO, and I can go to any doctor and submit the claims myself. Whether they pay or not is a different story. if they do they only pay a small amount. my prescriptions have been covered tho.
Posts: 615 | From maryland | Registered: Oct 2007
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
I found a doctor near me at a major hospital outside Philadelphia who claims to treat Lyme without a positive blood test and he takes insurance, so I found that odd. I don't think I'll be seeing him though.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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posted
I would ask what his treatment protocol is.
One thing we may all see due to the anti trust settlement is some more openess from the medical community.
I submitted the press release to all my drs in my circle and each and everyone of them stepped back a bit when I did so
One told me "you know, medicine is fluid. It is always changing and we learn new things." That is the first time he conceeded AT ALL to this possibility with me.
He is my internist and I do still see him. Until THAT his stance was no way and you shouldnt do the regimine you are on for Lyme if you did have it all.
We may see more of this!!!
-------------------- Seeking renewed health & vitality. --------------------------------- Do not take anything I say as medical advice - I am NOT a dr! Posts: 830 | From TN | Registered: Aug 2007
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
quote:Originally posted by cjnelson: I would ask what his treatment protocol is.
One thing we may all see due to the anti trust settlement is some more openess from the medical community.
I submitted the press release to all my drs in my circle and each and everyone of them stepped back a bit when I did so
One told me "you know, medicine is fluid. It is always changing and we learn new things." That is the first time he conceeded AT ALL to this possibility with me.
He is my internist and I do still see him. Until THAT his stance was no way and you shouldnt do the regimine you are on for Lyme if you did have it all.
We may see more of this!!!
I guess I could ask his protocol but since he takes insurance it through up a red flag to me.
I also know people rave about Dr. D. in PA, not far from Lancaster and he takes insurance so it is confusing.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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posted
My LLMD takes insurance. I have never had a problem. His specialty is actually Physical Medicine and Rehabilitation, but he is definitely an LLMD. I have been undergoing treatment since July 2006.
-------------------- "Few of us can do great things, but all of us can do small things with great love". Mother Theresa
richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
Okay, so this gets more confusing by the minute. If I am supposed to avoid LLMDs that take insurance, why do people have good luck and get long term treatment from them?
Do they also follow Dr. B's guidelines? I am going to look at Dr. D in PA and consider because it would save me money.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
my llmd takes insurance. he is cautious about the dx codes he uses and the wording used.
he also takes medicare, so while he is out of network for me between the two i don't have to pay too much out of pocket.
i happen to have very good insurance.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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Yes, some LLMD's do take insurance. There are many variables and nothing is black and white.
Many insurance companies make it so hard for an LLMD to take insurance that it's not really possible. They do this by wasting their time as much as possible with codeing and other stupid policies that are meant to make profits--not help ill people.
Many treatments for any illness come, not from doctors, but from insurance company clerks. Clerks prescribing, clerks diagnosing. It's insane.
Ask if the "LLMD" follows IDSA Guidelines or ILADS Guidelines. If they don't know the difference--don't go there.
Do they practice a rigid one-size-fits-all protocol of supplements and few antibiotics--and ignore what is happening to your body systems?
Or do they try to get at Lyme & company germs with aggressive antibiotics, and try to re-balance hormones and tend to body system problems caused by Lyme? In my mind, that's a real LLMD.
Please know that any doctor can set themselves up in business and call themselves an LLMD--and they may know nothing about Lyme. Ask if they are also an ILADS doctor.
richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
quote:Originally posted by lymednva: my llmd takes insurance. he is cautious about the dx codes he uses and the wording used.
he also takes medicare, so while he is out of network for me between the two i don't have to pay too much out of pocket.
i happen to have very good insurance.
Doesn't matter how good your insurance is if they don't take the insurance, correct???
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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bettyg
Unregistered
posted
.....
to all reading richie's thread, please go to activism right now!!
read the post about action MAY 21-23 .... IT'S ABOUT CALLING PALLONE, KENNEDY, AND HEALTH NOS. SHOWN .... 3 of them.
please call them BUT ESPECIALLY THE LAST PHONE NUMBER. that office has someone DEDICATED TO WORKING ON OUR BILL AND WORKING VERY HARD ON THIS !!!!
they are receiving OPPOSITION GALORE FROM IDSA/DUCKS .... they count EVERY PHONE CALL...
to all lymies, CALL ALL 3 NUMBERS PLEASE!! *********************************************
posted
My LLMD is in my network and takes my insurance. I also contacted my insurance company to see what other LLMD's (from my referral list here)and see Dr D outside Lancaster is actually in my network of docs. He is a 5-6 hour drive away.
I also see an integrative doctor that used to take my insurance but now he is strictly cash or CC. I have no idea why he changed but he is too valuable to me to not ever return.
Posts: 261 | From NW Pa ~ Crawford County | Registered: Oct 2007
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posted
Kaya's Mom-I know you are upset because your daughter is so ill, but please don't say that Dr. J won't work with ins companies. It's a matter of he can't.
The medical board is trying to persecute him for helping sick children, some as sick as Kaya.
Hopefully one day soon all TBD treatment will have to be covered by insurance.
Posts: 41 | From Warfordsburg,PA | Registered: May 2007
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
rich if you are talking about the ID dr near ridley i wouls stear clear of him. He feels that if you send water to Igenex you will get a positive.
Dr S, Tailz favorite dr (sarcasm) sent me to him, when he didnt want to deal with me.
I believe I am one of the worst cases around these parts....
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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I understood that some LLMD's typically have you pay upfront and some will file on your behalf but we still have to pay and hope we get reimbursed....
So now I am reading that many are taking insurance??? You pay a copay and thats it???
Please PM with WHO DOES THIS!!! I havent found anyone and cant afford it any other way so am self treating and quite frankly I would much rather not be doing that!!!!
I am on BCBS.
-------------------- Seeking renewed health & vitality. --------------------------------- Do not take anything I say as medical advice - I am NOT a dr! Posts: 830 | From TN | Registered: Aug 2007
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daise
Unregistered
posted
cj Nelson,
Great idea: PM for LLMD taking BCBS. I hope it works!
since you have bcbs, you should have their booklet, extensive, showing what they pay/don't pay, etc.
the web site should be in there; go to it, and then bring up area where it talks about PROVIDERS .... check to see who is in their IN NETWORK SERVICE OR NOT.
if you can't find info; call them and ask about specific drs....don't tell them they are a LLMD though ok!! good luck
i had to pay 100% except for some lab work covered...
mine was $5,000 for 3 months and $1,000 travel for out of state expenses. that's nothing compared to many of you folks!! i wasn't on IV!!
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
betty, 5,000 for abx!!!!!
I only saw Dr F in PA so far and he has me on Fluconazole but my health insurance covered it. I would think prescriptions are covered. What a mess!
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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daise
Unregistered
posted
Hi Kaya's Mom,
I haven't seen anyone on this thread trying to make an enemy of you. Facts have been stated.
quote: You wrote:
It seems I will have to disagree with the masses among these parts and agree with the insuarnce commissioner - the bulk of the LLMDs who do not accept insurance are doing so in order to charge whatever they want and get paid what they want to charge. They know we (or in my case, our loved ones) are left no choice but to pay what they demand. we suffer too bad to not do so.
No. ILADS LLMD's are not ripping us off. It is a fact that MANY have been in danger of losing their license to practice for a long time. That is a very big deal.
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
K's mom said... "I realize he is being prosecuted right now and indanger of losing his license from the medical board. But that has absolutely nothing to do with insurance."
Sorry k's mom..
This is a very complex situation. I am afraid you've been misinformed or haven't been around long enough to make the connection yet.
I wish I had time to list all the reasons why some- actually most- LLMD's can't take insurance.. but I don't have the time.
I did note you were taking your little one to a doctor who did take insurance.. and you are upset now because Dr. J doesn't take insurance.
You know the old saying.. "you get what you pay for?" Well, that holds true here. If you were able to find a doctor who can do what Dr. Jones can do (and know I truly believe in my heart of hearts that NO ONE can).. you should still be going there, don't you think?
If someone who takes insurance won't or can't treat someone.. what good is the insurance? You are paying insurance premiums for NOTHING!
What the LLMD's do is above and beyond anything I've ever seen before in the medical field or pretty much anywhere.
They have risked everything.. and every day they are under fire... mostly by insurance companies. Some have to have lawyers on retainer for the insurance threats and problems they get... and to also keep the medical board off their backs so they can treat.
Most LLMD's do what they do because they and/or family members needed help and couldn't get it... insurance or not. They are exceptional doctors, treating people as they would want to be treated.
On average, they typically spend 5 times longer with patients than a non-LLMD does... and the paper work keeps many of them busy until late in the night, nearly every night.
Many also live in an area where the cost of living is much higher than what you experience where you are... therefore... the overhead, costs, etc are much higher.
Example- The ones up north in NY, CT, etc... pay their nurses about 2-3 times what some places do. (We did a comparison years ago to show this point)
They also have top quality help. I know Dr. J's nurses work above and beyond any other office I've ever heard about anywhere... with a lot of overtime just to keep up with Dr. Jones.
And on top of it... they handle our most precious possessions... our children. There is no doubt they deserve the money and so much more.
I will provide one more example here just to give you an idea.
Dr. J in NC was hit by the medical board a couple years back for helping patients and stepping outside the idiots box.
Not only did the hearings and legal fees cost him a fortune... MANY MANY patients were left without help because of the situation.
He was fined and his license was suspended for a year... something devastating for anyone to handle. His reputation was smeared, he was stressed beyond belief... etc.
Now that is bad enough. BUT...
After all was said and done.. the insurance industry, who had been dogging him and other LLMD's for years.... decided that if he was not following the IDiot standard of care THEY like him to follow, because it is so much cheaper for them, in treating his patients... then he was committing fraud.
So they snuck in the back door to stick a knife in him to finish killing him off.
The insurance companies were responsible for cutting off everyone's access to help (patients) at that point.
Then they back dated the claims against him so all of the bills he submitted in the past were denied... leaving all the patients who THOUGHT they were covered stuck with all of the medical bills. Many of them lost everything because of the insurance companies.
THEN... as if that wasn't bad enough.. the insurance companies sued him because of the medical board decision. To the tune of 100's of millions of dollars.
Keep in mind an entire team of lawyers had to be paid out of pocket for years.
Keep in mind all of the employees there were out of work because of this situation (I believe there were 75 or more?)
Keep in mind because of the retaliation of these insurance companies he lost his entire business.. his new building.. everything.
He and his family had to start over from scratch and relocate. Patients had to find help elsewhere and were so strapped for money many never were able to find help.
And he had to explain that to his family.. how he MIGHT have made it.. but the insurance companies did him in... and hurt all of his patients.
Had he NOT taken any insurance in the first place, some folks would never have been treated there, true.
But he did take insurance and now NONE of these patients (including HIV/AIDS patients) can be treated and they don't have a doctor... and they all got stuck with bills that were suppose to be paid and done.... and they have suffered because of it.
Also note- insurance companies have been tied to the IDSA idiots. They were charged for it (the IDSA idiots) in the AG's recent press release.
The insurance industry IS behind much of the problem, but they are sneaky and needless to say.. powerful.
If a LLMD can take insurance... fine. But the ones who can't have good reasons not to. I have watched new LLMD's come on the scene over the years. Many could take insurance and did.
Then they were targeted. Once that happens.. they can't take it for fear of letting patients have NO help as opposed to SOME help.
By the way... I have never ever ever seen Dr. Jones turn away any child because they couldn't pay. Over 10,000 children and never once was anyone refused help. That is a blessing... and many don't even know that about him.
If the docs near you can say that... good for them... but I would serious doubt they can. I do hope this explanation will help you in your future.
LLMD's are the good guys. If you care to bash someone.. please help yourself to the IDSA idiots and the insurance companies. THEY are the reason this is happening.
-------------------- This is NOT medical advice - and should NOT be used to replace your MD's advice. Info is only the opinion of those who publish the site.
The shortest way to do many things is to do only one thing at a time.
cb Posts: 669 | From somewherebetweentherocks | Registered: Mar 2008
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daise
Unregistered
posted
Tincup,
I learned details that I hadn't known about. Thank you.
richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
Kayas Mom, I hope your little girl gets better! My heart goes out to you.
To everyone, thanks for the help! When I started having symptoms back in October, the first thing they thought of was Lyme, but my simple test at Quest was negative so they rules that out. At the time, I knew nothing about Lyme disease, co-infections, etc so I moved on looking for answers.
The Floaters continued, clusters of floaters, the burning in the feet, twitches, tremmors, temperature drops, spasms in back, odd cramps and pains, weak limbs, cracking neck, dental issues, sore throats, numb spots, wrist pain, hand turning grey, purple and blue, you name it....still no doctor had an answer.
Ao I started to thnk Lyme again and decided to find the right doctor for me. I wanted someone who would spend up to two hours with me the firt visit and somone who knows LYme well and can figure out what to do if I am not getting well following his/her protocol. Money is not the issue because I just want to get well.
I went to Dr. S. in Chadds Ford PA because he took insurance, and what a joke.
So, then I went to Dr. F in PA because he was cheap and spent a long time with me but only gave me antimicrobials....no abx.
Now, I just want the best I can find in the area or within 2-3 hours or so. I am considering Dr. D near Lancaster PA but I still worry because he takes insurance. I always thought it was impossible for a Lyme doc to take insurance since they would have to treat according to the insurance companies guidelines, not Burrascano's!
So, I ended up making an appointment with Dr. L in MD because she is highly recommended and spends 2 hours the first visit and she also trained under Burrascano so it all sounds good to me.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
K's mom said...
"I am not divulging any further opinions or points on the whole "lyme conspiracy" - case closed to me. I can't get distracted by the politics of this disease - I need to focus on getting my little girl back!"
100 percent right! I agree with helping your family first. ALWAYS!
mine was $5,000 for 3 months and $1,000 travel for out of state expenses. that's nothing compared to many of you folks!! i wasn't on IV!!
richie, you replied, $5,000 for abx! NO!!
NO! if you want to read my breakdown, etc.; it's all here, and also in the newbie package i sent you/others!
Bettyg's 4-20-06 new LLMD in Minn. Office visit summary, complete BODY lab results of 15-18 labs nationwide, all info the lab sent back about specific high/low testing, $$ costs involved, and what each test specifically involved what ...
VERY DETAILED! I did this for other newbies who had NEVER had complete body testing like I did! Hoped it would give them guidance what they entail, how costly if OUT OF POCKET PAID like my $ 5000, and which specific labs nationwide are the best for these SPECIFIC lab work.
METALLlC BLUE
Frequent Contributor (1K+ posts)
Member # 6628
posted
quote: I am not trying to make any enemies here, and I know that it is pretty unanimous amidst the Lyme community that Dr J is the best of the best (even my local PCP believes that to be the case and he isn't at all "lyme literate").
He is in the top 5 best Lyme Disease specialists in the world. He "is" the top Pediatric Lyme specialist in the world.
quote: But the fact is, he won't work with insurance companies, PERIOD. That is not a generalization of mine or some one sided opinion. Those words came straight from one of his office assistants/nurses.
Correct. He won't, because he can't. He can't, because they won't work with him. Being such a high profile physician who treats Chronic Lyme Disease, he isn't afforded the ability to use insurance and prescribe antibiotics to over 10,000 children (He's treated more than that, his office can confirm that). Given the enormous amount of patients requiring long term therapy, the insurance companies caught on that he wasn't following conventional guidelines and thus blackballed him.
quote: I realize he is being prosecuted right now and indanger of losing his license from the medical board. But that has absolutely nothing to do with insurance.
Actually this is incorrect, but let me explain it as briefly as possible. Dr. Jones is accused of diagnosing and treating children he'd never met via telephone from his east coast office, to a west coast mother.
Thus, Dr. Jones ends up before the CT medical board. The reason he ended up before the state medical board is because the mother could not receive adequate treatment from a competent Lyme Disease pediatric specialist in California, and the reason for that, is because the IDSA claims Chronic Lyme Doesn't exist (A society already known to violate the law), and thus doctors in general believe that truth, thus doctors do not practice or specialize in treating it.
If the IDSA -- who has been investigated and found allegedly guilty -- had not been dictating policy, the insurance companies would not be able to suppress coverage. If the correct information (Chronic Lyme and co-infections are real) where available. Doctors in general would practice, and prescribe for patients with the illness, thus the insurance companies would lose an enormous amount of money, especially when laws began being passed forcing that coverage should a doctor prescribe it.
So let's look at some facts about Dr. Jones and try to understand a little more about how this specifically applies to him:
Let's state some basic facts about Dr. Jones:
1: Dr. Jones is 79 years old
2: Dr. Jones has been a medical physician for 41 years
3: Dr. Jones is the best pediatric Lyme Specialist in the world (literally)
4: Dr. Jones only treats Lyme Disease and co-infections in children.
5: Dr. Jones has treated over 10,000 plus cases of Lyme Disease based on the medical records of his patients. Most have recovered full function.
6: Dr. Jones works in southern Connecticut near where Lyme Disease was first discovered in 1976-1977.
7: Dr. Jones noticed a severe increase in Juvenille Rheumatoid Arthritis in his practice in the early and mid 1970's.
8: Dr. Jones began treating these Juvenille cases immediately with antibiotics once it was discovered by a tick born Laboratory specialist that a bacteria found in the gut of ticks was the source of Lyme Disease.
9: The bacteria was discovered in 1982.
10: Dr. Jones therefore has treated Lyme Disease since 1982.
11: Dr. Jones then has 26 years of experience working with children with Lyme Disease.
(1) The panel of physicians who heard Dr. Jone's case were not specialized in Lyme Disease. There is a severe controversial divide in medical science between two different societies, both credible, who have opposing views on treating Lyme Disease. The Infectious Disease Society Of America vs. The international Lyme And Tick Born Disease Society.
The IDSA believe Lyme is hard to catch and easy to treat with short term antibiotics. The second group, ILADS believe Lyme Disease is quite common, especially in edemic areas like the North East, thus easy to catch, but they believe it hard to cure if it's not diagnosed immediately and treated immediately, thus they believe long term antibiotics must be used for persistent infection. This now leads to the boards conclusion.
It is based on a bias, and it's clear by the reprimand they're seeking. Having a physician standing over Dr. Jone's shoulder who is probably not a Lyme Specialist (Though Jone's will be responsible for hiring this person) could possibly dispute some cases (though doubtful), claiming Dr. Jones is overtreating and overdiagnosing the children he sees.
(2) Dr. Jones treated children who lived in Nervada which he'd never met, though they and their parents had spoken with Dr. Jones by phone and the mother had consulted their local physician about the issue.
Given the symptoms listed, Dr. Jones believed the risk of using antibiotics, should the patient have Lyme Disease, was lower than the benefit of allowing the children to get worse before he'd seen them in person. Dr. Jones did later see these children, a very brief time later. The children were cured and are entirely symptom free.
(3) The complaint was initiated by the children's father, who is involved in a custody dispute with their mother, an emergency room nurse.
After investigating the complaint, the health department brought charges to the medical board, alleging that Jones diagnosed Lyme disease in the children without examining them, that he failed to consider other causes for their symptoms, and that he improperly prescribed antibiotics.
Now remember, Dr. Jones has 26 years experience with Lyme Disease. Dr. Jones also had a full copy of the children's medical records, which the mother had sent. The mother who had the children is an Emergency Room Nurse, likely experienced with many illnesses, including noticing a pattern of possible Lyme Disease.
She thus consulted Dr. Jones. Also remember, the majority of medical experts believe long term antibiotics are unacceptable (This is where the controversy between those two groups is), which is what Dr. Jones prescribed for these children.
quote: As I've said, and I'll say it over and over again, no matter how "unpopular" it is: My family and I have very good insurance - they are doing their best to work with us on Kaya's treatment.
I can assure you, they aren't doing their best to work with you.
They're doing their best to minimize the damage done to their bottomline, and when it comes to Dr. Jones no "insurance company" would ever be so stupid as to allow someone like him into their network, where the cost of treatment would soar, crushing that bottomline they're so passionate about maintaining.
quote: There have been times that they've denied coverage for a brief moment, but our PCP talks to them and/or rebills under a different code and it is taken care of. They are DUMBFOUNDED at the fact that Dr. J won't work with them.
Your physician literally has to manipulate the code, in order to tell the insurance company what he's treating, even if his diagnosis is listed as another more specific code.
Think about that for a moment. Now imagine a Dr. treating 10,000 children, all of which are prescribed antibiotics, and -- say, just for the sake of being fair, Dr. Jones used "other" codes like your PCP. Do you have any idea how fast he'd be investigated, given his codes constantly result in long term antibiotic therapies?
The insurance companies know exactly what he's prescribing, because they originally were paying for it prior to his termination! He didn't terminate them, they terminated him!
quote: They don't live in a bubble. They know about the Lyme treatment controversy - but that isn't at issue. Our PCP is the one who actually prescribes her antibiotics, so they are getting taken care of (for the most part).
And that is why you're getting the antibiotics, because your PCP is prescribing them, not Dr. Jones. The insurance company doesn't make the connection, nor can they legally -- to you seeing Dr. Jones "Without insurance" to your PCP, "With insurance" -- they don't know.
Your PCP doesn't constantly prescribe antibiotics for Lyme, he's only doing it for you and a select few other patients who probably come with the same problems your child is having.
quote: It seems I will have to disagree with the masses among these parts and agree with the insuarnce commissioner - the bulk of the LLMDs who do not accept insurance are doing so in order to charge whatever they want and get paid what they want to charge.
They know we (or in my case, our loved ones) are left no choice but to pay what they demand. we suffer too bad to not do so.
By now, I've explained why LLMD's -- who specialize in tick-borne illness, thus treat with nothing but long term antibiotics -- are forced in many cases to treat without insurance.
The costs of LLMD's are no higher than any other specialist you see. The pricing is normally 400-800 for an initial consult with a Neurologist who doesn't specialize in Lyme, but since they aren't treating controversial illness with the same therapy over and over, the insurance company plays ball.
They physican makes a smaller fee, but as a result sees more patients who couldn't otherwise afford to see him or her -- hence "managed care"
The second issue, some LLMD's treat other conditions, and thus their treatment protocols aren't the same across the board.
These other LLMD's often also work with the local PCP as much as possible in order to run the long term antibiotics through these other physician in order to spread out costs and to prevent provoking notice from the medical boards or insurance companies.
The more prominent a specialist is in the Lyme community, the less likely they'll take insurance. The one insurance that many LLMD's will take is state insurance in states which approve or protect doctors in treatment of Lyme Disease like RI, Massachusetts, and some other areas.
Claiming LLMD's are out to make money is simply false. They are forced to see less patients as the field of Chronic Lyme requires extensively long consults, reading of medical records, talking to the patients other doctors, handling emergency room calls from these patients.
Thus they see less patients, so the cost is higher to maintain their clinic -- which they normally run alone, as a result of other doctors not wanting to be involved in the controversy of treating such an illness.
Lyme Disease specialists who take insurance have been confirmed by patients across the board to spend less time with patients, especially during follow-ups, are harder, if not impossible to reach by phone, have difficulty working with local doctors and often request the doctors call them instead of they calling the PCP's or other specialists.
Lyme Disease specialists also must maintain higher levels of malpractice insurance -- not as a result of being a poor doctor, but rather because of the risk of treating a controversial disease that often results in disasters and emergencies.
This ****es families off, who then lash out at the LLMD, when the fact is, the patients get much worse -- even when told by the doctor that it will happen -- and thus then blame the doctor for the care provided. It only takes one or two patients to report a doctor and to have that doctors medical ID threatened.
These are the facts, these are "not" assumptions, this is the reality of the world in which LLMD's practice, and patients suffer.
quote: To all of those that claim "a real LLMD" wouldn't take insurance -as I said, the very first LLMD that we took our daughter to, found through the ILADS site, does take insurance and was even in our network. There are truly doctors out there that are fully educated about the necessary way to treat Lyme disease who DO accept insurance.
That's correct there are some, but it varries from state to state, as well as to the prominence of the physician, and whether or not he treats other illnesses aside from Lyme. Most LLMD's are specialized in a field totally independent of Lyme Disease or tick-borne infections. They may be even OBGYN's, who see women for traditional medical approintments, the next patient may be a male needing treatment for Lyme Disease!
The difference is huge, because whatever alerts the insurance company, will cause the insurance company to abandon a doctor, if no law prevents otherwise.
I hope this helps you to understand the mechanics, politics, and the facts because the financial machine that drives privatized medical care.
[ 01. June 2008, 03:34 AM: Message edited by: METALLlC BLUE ]
-------------------- I am not a physician, so do your own research to confirm any ideas given and then speak with a health care provider you trust.
posted
metallic michael, PLEASE CLEAN OUT YOUR PM BOX; IT'S FULL.
michael, please go back to your detailed post above, and please break up the LONG SOLID BLOCK TEXT so we neuro lymies can comprehend and read it. i want to read this too!!
thanks for having patience to type this much info as well; could read a little but then the paragraphs kept getting longer and had to quit.
please edit by clicking on paper/pencil to open up your text; BIG THANKS!
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METALLlC BLUE
Frequent Contributor (1K+ posts)
Member # 6628
posted
Done, and Done. BettyG.
-------------------- I am not a physician, so do your own research to confirm any ideas given and then speak with a health care provider you trust.
Did you know that they have LymeAid for Kids at Dr J's office?
That is what I had to fill out for because I couldnt afford the cost of the appointment + tests, etc..... They give you an account with a certain amount of money in it.
Maybe you could fill out the application for this so it could help out a little with the cost.
I know they dont take insurance and it is REALLY expensive, but I am glad they had The Lyme Aid for kids available. If not I would not have been able to bring my son to Dr J.
It is so expensive right now. I have to see an LLMD because I am sick, my son is sick, my fiance is now sick and needs to see an LLMD and I praying my 1 year old will be safe from this insanity.
We are all seeing different LLMD's ... Me and my fiance cannot afford to see the same LLMD because of Cost. He is seeing one who takes insurance. I am seeing someone a little more agressive because I am very very ill. My son is seeing Dr. J for obvious resaons....
I know it is SO hard Kaya's mom..... PLease try and fill out that application...It could help even if just a little.
-------------------- "You'll be surprised to know how far you can go from the point you thought it was the end" Posts: 946 | From Massachusetts | Registered: Apr 2008
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bettyg
Unregistered
posted
michael,
KUDOS MY FRIEND FOR BREAKING UP YOUR LONG POST! you had great informative info in there!!
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
So, does this mean any time you go to a doctor who does not take insurance, you will be paying outof pocket for meds? I see Dr. F in PA and my insurance covers meds so far.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
rich- most insurance plans dont link the treating dr to the coverage, unless it is IV... from my experience with reading this board anyway.
I had no problem getting insurance to pay for abx.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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bettyg
Unregistered
posted
my prescriptions were covered;
my supplementals weren't...$1,000 for one month **********************************************
that included 3 PRESCRIPTION COMPOUNDED MEDS which i fought and won on gettin reimbursed for them!
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
I am seeing Dr. L in MD next month and wonder if she will thikn I have Lyme or send me on my way. I hope she has a keen eye for this since we will be paying a lot for the visit and labs. I may plead with my insurance to pay the labs at Igenex.
My case is so confusing because I have MGUS(Monoclonal Gammopathy of Undetermine significance) so I don't know what is causing what symptoms or if this is psychogenic pain. All I know is that I had no symptoms till last summer then it took off like a rocket.
I don't even know if I have Lyme since i am only going off Dr. F's diagnosis and he never orders tests since he agrees for the most part, they are a waste of time and money.
It is difficult not knowing what I have and spending over $1000 to see if I actually have Lyme. If I don't, I am back to square one, looking and searching. for this reason it is really tempting to go to a doc who takes insurance assuming he/she really knows how to diagnose Lyme. Dr. D in PA is tempting!
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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bettyg
Unregistered
posted
richie,
have you been approved for SSDI, disability insurance benefits?
if yes, do you have your 2 yrs. in so you are NOW COVERED BY MEDICARE?
medicare patients; IT'S FREE TESTING AT IGENEX! they do the paperwork too1
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
quote:Originally posted by bettyg: richie,
have you been approved for SSDI, disability insurance benefits?
if yes, do you have your 2 yrs. in so you are NOW COVERED BY MEDICARE?
medicare patients; IT'S FREE TESTING AT IGENEX! they do the paperwork too1
I guess I could ask my benefits department. I have Aetna insurance...is that through them?
I was out on dissability for a shoulder injury two years ago. I was out 5 weeks.
What do you mean, two years in???? In to work or in to dissability. I don't follow.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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daise
Unregistered
posted
Hi Richedie,
Betty is referring to Social Security Disability (SSDI.) You get Medicare, sooner or later, when you get SSDI.
Some LLMD's take Medicare (but not necessarily a Medicare Advantage Plan.)
richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
Daise, how would I know? I thought that was later in life?
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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