Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
It came to my attention while watching Under Our Skin a big-big reason why LLMD's would not accept insurance, nor be a prefered medical provider for any insurer.
#1. The Dr's must sign a contract with the insurer that says they will "Treat within the Standard of Care", and are basically under the watch of the insurance company.
If not they can be immediately removed from the panel and subjet to PEER/other Dr review.
2. This opens their charts/records to routine audits by insurance companies & other Dr's that work for the insurance company.
3. This subjects ALL the physicians billings to review.
4. Most complaints to State Medical Boards- DO come from insurance companies-- as they see all the claims, and costs. Especially those that vary from the norm.
i.e. Going to 15-20 doctors on a Dx hunt is fine, but get Dx with Lyme and your benefits can be limited.
5. Reimbursement for a standard office visit follow-up comtemplates appx 5-7 minutes of time. Most LLMD take 5-10 times longer per visit.
6. Insurance companies push a lot of extra paper work on physicians to justify Dx and treatment-- especially for any type of cronic care.
Last- the insurance company will only pay what they pay for reasonable and customary care- which is about $90-170 per visit.
In the end it really is alot easier to submit your own bill to your insurer for reimbursement and let your LLMD help others, not process paperwork.
I would like to see more educated doctors and more that would accept insurance, but this is not going to happen until a more broad standard of care is accepted by insurers.
Hopefully after the IDSA guidelines review, but I would not get my hopes up too high for this.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Thank you T for sharing that information.
I see what you are saying every day just about.. and I am glad you took time to spell it all out for others.
I think this should be a post that is used frequently.... because if I get asked once.. I get asked a zilllion times why doctors we go to for our care, can't take insurance.
Then, because they don't understand, people blame the LLMD's and say they are "only in it for the money".
They really don't understand... then bash the LLMD's because of it.
This would help these folks a lot! Thank you, thank you!
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
-
Tracy,
Yeah, I kind of knew some of that but by your counting out reasons for us, it really clears it up. Thanks. Your post should be kept handy. This question gets asked all the time.
posted
very few of my doctors participate in my insurance plan. i have been going to all out-of-network dr's lately. i find I get better care this way.
my neurologist, even my surgeon who is doing my surgery is out of network.
i would rather pay the 20% and get better care.
Posts: 615 | From maryland | Registered: Oct 2007
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daise
Unregistered
posted
Hi Tracy,
This is a valuable thread. We can refer to it. Thank you.
posted
Right on TRACY!!!! The insurance companies are not only unethical to patients, but to doctors as well. Under Our Skin does illucidate their reasoning for not taking insurance. Not being in network gives our doctors some much needed freedom to treat without being confined to the insurance company's unethical treatment regulations. Dr. J is being sued by an insurance company for treating on the CDC's "clinical basis." History will certainly absolve our LLMDs...in time.
-------------------- Mountaingirl
"What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson Posts: 138 | From West Virginia | Registered: Sep 2007
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Cobweb
Unregistered
posted
I was told straight up by an LLMD psych person that it was so the insurance companies couldn't dictate the treatment plan or tell them how to treat.
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bettyg
Unregistered
posted
tracy,
i'll add your well-written, clear post to my newbie package as well!! WELL DONE!
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Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
I have a confession to make, my husband Blake wrote this. I guess I was logged onto the computer at the time, and he didn't realize it.
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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posted
Thx, Tracy, for spelling it out so clearly here what the problems are for the Lyme-treating docs.
Only problem is, many of us cannot go to a doctor because we do not have the money to pay them. I have insurance. Any other health condition I have, I can see a doctor with my insurance. But not for Lyme disease, which took my health away. So I've had to figure it out myself what I try.
I am able to see a homeopathy doctor because he takes my insurance. And the remedy for 3-4 months supply costs five bucks!!
I wish a fund for lyme patients could be started by really wealthy people so that people who can't get to a doctor could.
Posts: 13116 | From San Francisco | Registered: May 2006
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posted
Great explanation of why docs don't/can't take insurance but here's the thing.
MANY lyme patients don't have the upfront money to pay out and then get reimbursed. They are left in terribly predicaments and their health goes downhill because of it.
Up and until the laws change, insurance companies stop being the police, many, many lyme patients will become sicker simply because of the lack of money.
"First do no harm".....
I think some lyme docs should try to take more and make more payment plans.
-------------------- ...~*Just keep swimming, Just keep swimming*~... Posts: 120 | From New Jersey | Registered: May 2006
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tailz
Unregistered
posted
I still think they are in it for the money. If they are worried about an insurance audit, what this really boils down to in the end is money anyway.
Sorry - I've no sympathy for the plight of doctors - not after what they did to my teeth and gums, for one thing. I've no dental insurance.
My attitude is that if enough doctors banded together and began to treat Lyme outside of the current guidelines, then the insurance companies would be up against more doctors than they could possibly handle and would have to listen, because, without doctors, the insurance companies would go under.
So, in my opinion, doctors are wimping out on most of us, catering only to the well-to-do.
My former LLMD told me he treats his family for Lyme, so he's not worried. I imagine most doctors realize that the current CDC/IDSA guidelines won't ever impact them directly because of this, and if it doesn't impact you, well then, why suffer?
So I sure hope the medical records request letter I'd sent to one of these doctors contained some germs, because I made a point of it to lick and salivate around the entire perimeter of it before I stuffed it in the envelope. This was before I knew I had Lyme, but I knew I had some infection.
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posted
I totally understand what's been said about their reasoning.
It would be nice though to see them do a little bit of charity work for the less fortunate.
Perhaps use a sliding fee scale for some and/or see some for free, with proof of income, of course.
Perhaps allow for a set number and even have a waiting list, where when one patient gets well, thus an opening becomes available, another less fortunate person takes their place.
I must admit, I do have to wonder, if they're truly interested in helping people get well, then how come they don't???
I realize, they can't do it for everyone, but would a few really hurt???
Besides, a lot of other doctors do it, but to my knowledge, not one of them do, do they???
Imagine if each one did that, even to a small degree, how many less fortunate people they could help get well, who aren't able to otherwise!!!
Anyway, that's just my two cents.
-------------------- My Lyme dx:11/05. My Mom's Lyme dx:5/16. ISO ASAP-Lyme Literate Dr & Neurologist-Prefer IL, IN, KY, MO, OH, TN. Can travel farther. Finances limited. Prefer Drs take Medicare or Payments. Need great list to find best fit. Tyvm. Posts: 701 | From Owensboro, KY | Registered: Sep 2005
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