posted
I just received this press release. Thought it may be of interest to you all. I took out the full names. I have a contact name and number if anyone is interested.
FOR IMMEDIATE RELEASE July 29, 2009 Contact: M N (267)
Independence Blue Cross Rejects Vision-Saving, Doctor-Recommended Treatment for Lyme Disease Patient
Patient Suing Healthcare Giant to get Access to Critical Medicine
Philadelphia, PA - C L of C, Pennsylvania has filed a motion for a preliminary injunction against his healthcare provider, Independence Blue Cross (IBX), in order to force them to pay for treatment to cure his ongoing Lyme Disease and save his eyesight.
The motion was filed in the Philadelphia County Court of Common Pleas by D S of the firm C, B, M, and C. ``Independence Blue Cross has ignored the advice of multiple medical experts and acted so irrationally that we have no choice but to seek an injunction to force them to help save Mr. L's vision,'' said S. ``At a time when the entire country is debating healthcare reform, this is a powerful example of what's wrong with the system.
Since contracting Lyme Disease in July of 2007, Mr. L has suffered from consistent, persistent vision problems including macular puckering, vitritis, opacities secondary to vasculitis, and moderate cataract.
During that time, Mr. L has seen several doctors: Dr. B., a physician specializing in the treatment of Lyme Disease; Dr.G, an ophthalmologist; Dr.S, a neuro-ophthalmologist; and Dr. S, also an ophthalmologist.
Each of his physicians have determined that Mr. L's eyesight is at risk and have recommended some course of IV antibiotics, however IBX's response to the doctors' recommendations has been, at best, inconsistent.
IBX DECISION 1: REJECT COVERAGE In the summer of 2008 Dr. B and Dr. G both recommended an intravenous course of the antibiotic, Rocephin. Dr. B provided the prescription for which IBX denied coverage stating that ``the medical history does not establish that the request for . . . intravenous antibiotic (rocephin) therapy . . . is indicated for the condition reported.'' IBX also rejected two subsequent appeals stating that ``repeat or prolonged courses of IV antibiotic therapy are not considered medically necessary and therefore not covered.'' As a result of the his deteriorating health and on the advice of his physicians, Mr. L commenced the recommended IV therapy treatment and paid for the treatment himself at a great expense.
IBX DECISION 2: APPROVE COVERAGE In the spring of 2009, Mr. L consulted doctors G and S separately, both of whom assessed that Mr. L's vision problems were continuing. Dr. S recommended to Mr. L's original physician, Dr. B, that Mr. L begin an intravenous course of the antibiotic, Doxycycline. Dr. B prescribed IV Doxycycline and, in an abrupt about-face, IBX approved the coverage.
Subsequent to his treatment, Mr. L began to make progress. By the fourth week of the therapy he had increased energy, his right eye floaters had decreased, the itchiness of his skin had improved, and his sense of well-being was the best it had been since his initial tick bite and treatment in 2007.
IBX DECISION 3: REJECT COVERAGE However, after four weeks of treatment, although Mr. L was making progress, he developed what is known as a right foot drop. According to his doctors, the presence of this new right foot drop was consistent with ``organism die off,'' meaning that the Lyme Disease was disappearing, but had not been completely treated. Accordingly, another 30 days of intravenous Doxycycline was prescribed.
Oddly, IBX denied coverage for the requested continuation of IV Doxycycline stating that the services requested were not ``medically necessary.'' Mr. L twice appealed IBX's decision and both appeals were rejected.
``It is the considered medical judgment of four different doctors that Mr. L needs this treatment or he will lose his eyesight, permanently,'' added Mr. S.
``It has been proven effective and IBX itself has approved it once. For them to deny coverage now that Mr. L is so close to being cured is cruel and reprehensible. We are going to aggressively pursue this case so that Mr. L has a chance to make full recovery.'' # # #
Posts: 1 | From USA | Registered: Jul 2009
| IP: Logged |
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Hey sparky...
Sorry... It's Sparty, not sparky.
Good info and very helpful.
Thanks for posting.
If you would be so kind as to send me more info... it would be much appreciated.
posted
tincup, when you get this, would you send to me by regular email since my PRIVATE MESSAGE BOX IS DOWN...messed up good & i can NOT send or receive anything! thx my friend.
sparty, welcome and thanks so much for the very informative info that we all discuss and cuss regularly!
Welcome; I'm so glad you found us!! You've come to the right place for education and support!
Betty's suggested POSTING GUIDELINES . many of us have neuro lyme where we can NOT read long solid block text and be able to comprehend and read it as is.
please edit your post by CLICKING PAPER/PENCIL ICON to right of your name. that opens up BOTH subject line and body text.
now please break up your WORDY SENTENCES into one sentence paragraphs. Then hit ENTER KEY ``TWICE`` after each paragraph; we need that space for comprehension.
then go to left hand corner and mark box to receive ALL REPLIES, and click EDIT SEND
we thank you for helping us; otherwise, we will SOB, SCROLL ON BY, since we can't read to help you. If I see posts like this, I SOB them; to hard on me. ----------------------------------------------------
I found Turn the Corner Foundation through the website for the Under Our Skin movie. Here is the link for their website. At the bottom of their webpage there is a link to click if you are interested in getting help finding and LLMD.
I emailed them for help and got a response with the names of over 10 LLMDS in two states in less than a days time. What an incredible blessing! Thought I'd pass it on. By member Aimee, 7.11.09 ------------------------------------------------------
People seeking doctors might be able to get help from their state online information and support group. Nearly 3,400 people belong to state groups. Some of the groups are small but more than 20 of them have 50 or more people and seven have over 100.
The groups are moderated and you have to apply. Most don't allow doctor names, but once on the group, you can ask for doctors in a certain area and ask people to email you privately. *******************************************
This explains the medical politics around lyme WHY you need an ILADS-educated or ILADS-member LLMD (and there are also some ILADS-member LL NDs (naturopathic doctors):
You should also be evaluated for coinfections. Not all tests are great in that regard, either, but a good LLMD can evaluate you and then guide you in testing. One of the top labs is:
"With most infections, your immune system first forms IgM antibodies, then in about 2 to 4 weeks, you see IgG antibodies. In some infections, IgG antibodies may be detectable for years.
Because Borrelia burgdorferi is a chronic persistent infection that may last for decades, you would think patients with chronic symptoms would have positive IgG Western blots.
But actually, more IgM blots are positive in chronic borreliosis than IgG. Every time Borrelia burgdorferi reproduces itself, it may stimulate the immune system to form new IgM antibodies.
Some patients have both IgG and IgM blots positive. But if either the IgG or IgM blot is positive, overall it is a positive result.
Response to antibiotics is the same if either is positive, or both. Some antibodies against the borrelia are given more significance if they are IgG versus IgM, or vice versa.
Since this is a chronic persistent infection, this does not make a lot of sense to me. A newly formed Borrelia burgdorferi should have the same antigen parts as the previous bacteria that produced it.
But anyway, from my clinical experience, these borrelia associated bands usually predict a clinical change in symptoms with antibiotics, regardless of whether they are IgG or IgM." ===========
ILADS The International Lyme and Associated Diseases Society (ILADS) provides a forum for health science professionals to share their wealth of knowledge regarding the management of Lyme and associated diseases.
UNDER OUR SKIN dvd LYME DISEASE documentary, www.lymediseasefilm.com go to this site to view trailer of UNDER OUR SKIN 5 min. Clip! Premiering 2008!! on big screen 09 in 10 LARGE CITIES ONLY!
* Please note: What you are about to read below is NOT meant to scare any of you from any lyme testings done; it's meant to be informed PRIOR to going into having various tests done and then be told what the costs will be! * Mine was sticker $$ shock on various testings done by my 2nd LLMD/new to me in 4=06. Those tests/results are found elsewhere in my links/advise.
* Igenex's charges for these below things cost $905, which I figured up the last 2 days for 2 other folks includes
* The below tests were done for ME; you MAY NOT NEED them all ok! :
* western blot IGM & IGG, this is MANDATORY for you which costs $200 total for 2 tests done; 6.09 same prices still. * * ******************************************************* * OPTIONAL ONES ARE:
* co-infection panel for YOUR AREA OF COUNTRY; * PCR WHOLE BLOOD...this is what my LLMD ordered!
It's PREPAY! unless you are on medicare; IGX will file the paperwork & it's FREE to you.
go to www.igenex.com and read over their info. Prices go up twice a year: MAY and NOVEMBER!!
* * have blood drawn MON. or TUES. only; you don't want your blood sitting in post office over the weekend; will ruin the results!
* Also, call 1-800.832.3200 for CURRENT PRICES! * They will also send you a ``test kit'' with their required form, all the test vials, & box to ship it in! OUT OF USA will take longer to receive!
* You need to DOWNLOAD IGENEX's required form.****************************************************** * * MD, DO ,ND, AC, DC are all fine** must sign, date, and show DIAGNOSIS CODE on there why he's ordering the test.
Make sure you show to FAX results and SNAIL MAIL PAPER COPY! My results were lost for 4-5 weeks! Bettyg * * When you get your results, please post them in MEDICAL; * Post ONLY the POSITIVE & IND ones .... not the negative ones!
GET COPIES OF ALL YOUR SPECIAL BLOOD TESTS: western blot igm/igg and/or co-infection tests always!!
OVERSEAS INSTRUCTIONS FOR SENDING TO IGENEX/FRY LABORATORY! 2-23-08
AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
Thanks Sparty for sharing this news. BC/BS did the same thing to me when I had developed Optic Neuritis & Uhthoff's phenomenon.
Dr.S (neuro-opth) suggested MS secondary to Lyme, SPECT scan radiologist said Neuro-Lyme. I had lab results positive for Lyme & multiple co-infections & they shut me down after 4 weeks, saying that the SPECT wasn't proof enough.
They demanded that I subject myself to a Lumbar Puncture, which would be a painful, risky and medically unnecessary procedure, or a Neuropsych evaluation also unnecessary as SPECT results are recognized as proof of neuro involvement.
I would have had to sideline my treatment to jump through their hoops, effectively setting back my treatment to render the first 4 weeks a waste of time and money.
I had to borrow to pay out-of-pocket for another 8 weeks to continue therapy and those symptoms, knock wood, do seem to have been eradicated with further treatment.
Those (expletive deleted) would have sentenced me to remain ill & continue to decline. I'm so glad to see someone calling them out for this.
I think it is despicable that they take advantage of the fact that many with neurological Lyme just can't get it together to fight back & jump through their hoops to file appeals and to get additional unnecessary tests on top of those which were needed & actually useful.
Why would someone who has medical proof of neurological lyme want to have an LP done when there is little chance of actually finding anything in the CSF, just so THEY could have a negative test?
They'd have to PAY for that procedure, as well. Why would they want to do that when there was already proof, unless they were fairly certain they could use the results to avoid paying?
I personally despise BC/BS. I think that they must be run by evil, inhumane, greed-stricken people. I really hope that this suit has a positive outcome for Mr.L and something will be done to make them cease their unfair evasive maneuvers.
I'm sending up a prayer for Mr.L. I hope that he is able to force them to cover the treatment he needs and that a sympathetic judge might decide to seriously penalize BC/BS.
May God bless his attorneys as well.
I was afraid to call them out on it because I was afraid they'd use their dirty tactics to try to go after my doctor in retaliation.
:cussing: BC/BS :cussing:
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/