posted
ive just started my Lyme treatment, and already my health insurance (Horizon Blue Cross Blue Shield) is giving me and my LLMD a hard time...not allowing him to prescribe me certain medications/or certain doses he recommends. Is this common? How do you guys handle this? Should I be expecting tons of out of pocket costs?
Posts: 132 | From jersey | Registered: May 2010
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posted
I have been ok on the meds. I still have yet to file my LLMD visits, but it's on my list. They have also paid for several blood tests (not Igenex) and a lumbar puncture.
-------------------- Lyme, Bart, possible Babs Currently on IV Doxy, Bactrim, Zithromax, Nystatin, Mepron Been on nearly every antibiotic since 10/09
posted
Oh, yes, they do pay for my bloodwork too, as long as it's through LabCorp.
They wouldn't pay anything for my doctor visits and I didn't even bother with the IGeneX cause I didn't want to raise the Lyme flag.
Then, I find out IGeneX informs the CDC who tests CDC positive with their lab, so I'm assuming I'm known now anyway.
Posts: 217 | From Earth | Registered: Feb 2010
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
I have UHC. They pay for most of my prescriptions and my secondary does too. UHC also pays around 80% towards my doctor visits with my LLMD. They pay for various tests as well. I'm sure it depends a great deal on the specifics of your particular policy. Knowing the insurance company can be helpful in some ways but it really depends on *your* policy as to whether something will be covered or not.
Getting UHC to pay is sometimes like pulling teeth. I have spent many hours on the phone and at one point when they kept conveniently losing paperwork from my doctor's office I told them I finally got a copy for myself and I'd be happy to fax it to them 100's of times until they got it. They suddenly got it the very first time I faxed it to them.
I would fight them tooth and nail if you can. It is energy and time consuming though and if you are really sick and can pay for it yourself you might decide to put your energy elsewhere. Personally, I don't intend to let them get away with paying a penny less than I can squeeze out of them.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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im so much worried about them not covering the igenex or doctor's visits...but if theyre gonna start denying prescriptions were gonna go 12 rounds on that one. thatd just be ridiculous
Posts: 132 | From jersey | Registered: May 2010
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posted
I am in the same boat. I want to submit. The first time I did I submitted IGenix and my LLND. They didn't pay and requested chart notes. That was right after I read everything I could get my hands on and thought, oh well, if they will pay for prescriptions I can do the rest.
Well now my husband has Lyme and co too. So the monthly LLND appointments and my daughters LLMD psychiatrist are almost $1000 per month.
Then we have prescription copay's of about $250 month. The cost of these would be well over $3000 if we had to out of pocket.
Then I have supplements to buy too. So our total cost is about $2000 per month. I've maxed out credit cards and my savings is gone. I am the only one working in my family (the only one who can).
So right now I have $7500 in un-reimbursed costs and have a huge dilema. Do I submit and tell the insurance we have Lyme? Do I take the chance that they'll quit paying for abx too?
I am so mad about this! I think it is so wrong....
Sorry Yankees, yes I guess you should expect a lot of out of pocket costs.
Posts: 333 | From Lyme Here Too | Registered: Mar 2010
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