seekhelp
Frequent Contributor (5K+ posts)
Member # 15067
posted
The common answer and most popular on Lymenet is insurers force docs to follow standard treatment and Lyme treatment is anything but. They need to operate outside of the box to treat sick people. Also time constraints exist if insurers are in the pics.
Another issue is major insurers don't like paying $900-$1,000 for a visit too. A bit outside the range of reasonale and customary!!!
Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008
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posted
Some plans may reimburse you for part of the visit. Mine didn't want to pay for the entire visit because they felt it was priced too high, so they paid for part of it. It's better than nothing.
Posts: 134 | From NY | Registered: Aug 2009
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Insurance companies tend to want to deny coverage for chronic lyme disease based on the IDSA guidelines. As you probably know, the IDSA guidelines deny chronic lyme disease exists.
It is true that insurance companies will try to strong arm doctors into treating under their guidelines. If the doctor refuses, they will be dropped. This happens to doctors who treat chronic lyme disease and to doctors who don't. I've had 2 of my doctors opt out of taking insurance because the insurance company was trying to force them to stop treating the way they saw fit. It is not unique to lyme disease and it is not new. It's been going on for decades.
seek wrote: Another issue is major insurers don't like paying $900-$1,000 for a visit too. A bit outside the range of reasonale and customary!!!
I've never paid $900+ for a visit to an LLMD. My first visit 3 years ago was $425. After that it was less than 1/2 of that. Rates vary based on the location.
Most LLMD's spend a lot of time - hours - in the first appointment because it takes time to gather and evaluate the data required to determine if a person should be clinically diagnosed with lyme and or co-infections. Lyme patients tend to be complex and most doctors simply refuse to deal with our issues. Too time consuming and controversial.
Years ago I had a 15 minute consult with a specialist who charged my insurance company over $400 so I don't think it should be viewed as unreasonable for an LLMD to charge $900 for a 2 hour appointment. You get what you pay for.
My current insurance company will pay 70% of my doctor appointment based on "reasonable and customary" charges. The reasonable and customary charges are typically based on 15 minute appointments. I have to bill them myself but my LLMD gives me the invoice necessary to do so.
The big difference between seeing a doctor who is a preferred provider with your insurance company and one who is not is that they agree to charge only a certain amount of money for your appointment. They must write off the rest. Doesn't work well if they are spending 10x's as long with one patient as other doctors. They can see a lot fewer patients.
Personally, I find that the majority of my cost of treatment has been medications and travel expenses. Whether your LLMD is a preferred provider with your insurance company or not will make no difference in those expenses.
You could search the archives for more discussion about this issue. It's been talked about a lot.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
At this point I feel fortunate to be able to work within my insurance company for my LLMD. I seem to be getting better but perhaps I am not as sick as some of you and I sense this doc would only goes so far for so long (ie no IV antibiotics). It is too bad people with lyme do not have better access.
I hope in the future more research will give us clearer answers.
Posts: 207 | From NH | Registered: Jul 2009
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A bit outside the range of reasonale and customary!!!
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