Topic: NY State Insurance Board--do they follow IDSA Guidelines or support tx of IV abx?
Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
Who has had a denial in NY state and has had it go to the NY State Insurance Board for an Appeal? If so, what did they decide--in favor of IV tx? How do I find out how they ordinarily treat Lyme tx?
Lorraine Johnson, in her testimony to the IDSA panel said that states usually use ID doctors to make the decision!!
I have been denied IV tx by Oxford in NY after 8 weeks of tx. I just had a big improvement when they denied further tx!
And right after that I got another tick bite and went rapidly downhill again---worse than before! The new tick bite was mentioned in my letter and the office notes. It was an ID doctor who cited IDSA Guidelines word for word---"not medically necessary, experimental, not standard of care."
I appealed, and it was denied again. I used CALDA's info, 2 letters of medical necessity, office notes a long letter from me, and a raft of published studies showing persistance of borrelia after short term tx. But they didn't read anything, and denied it again.
It is now in Second Level Appeal.
Third Level Appeal goes to NY Insurance Board, and their decision is binding. I'm afraid to leave the decision to them, if it comes to that. Any experience or knowledge of this??
Posts: 3771 | From around | Registered: Mar 2008
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posted
Have you contacted support groups in the state? If you don't get an answer here, try them, as they will probably know of appeal cases.
Posts: 8430 | From Not available | Registered: Oct 2000
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bettyg
Unregistered
posted
do a search for TIMACA, member ....
click on directory type in timaca click search
write down her member no.
now do a search
appealing health insurance medical subject line any date and show timaca's no. click search
read all posts/replies shown; she was able to WIN back $50 - $100,000 ?? 3
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