Have been on a never-ending wait list for my first choice LLMD, who takes my insurance (ok, it's really only been 5 mos, just feels like forever) I'll see her at the end of Aug...

In the meantime, have received confusing test results from my non-LLNP: Quest says I'm IgM pos for babs, and CO Tick Fever, only band 41kd on WB. She's telling me I'm neg for Lyme, neg for Babs, and don't need treatment for those. But yet I'm in my 3rd month of doxy, and herxing. I'm confused.

Since my NP doesn't know what to do with me, I somehow squeezed myself into a "backup" LLMD appt last week, my second choice, also took my insurance - no one here seemed to have heard of him. Long story short, his office called day before my appt & told me he wouldn't be taking Lyme patients any longer! I'd waited 6 weeks for this one... I was crushed.

Jumped back on the horse though, and after much calling around, have found another LLMD who can get me in sooner than Aug, and if I need treatment, I'll switch over to my first choice in Aug, and they will collaborate.

Here's the catch though: this LLMD doesn't take any insurance. Pretty normal, right? How often does insurance reimburse the fees? Do I kiss that check good-bye for good? (Is it ok to say how much his first appt runs here?) With flights & appt, I'm looking at more than a thousand dollar outing, and that's before any testing or treatment. Is that in the normal cost range?

My primary concern is that I don't want to do anything to jeopardize my future coverage, with my first choice, local LLMD when I get to see her in Aug. Would filing a claim from the first LLMD, and having it denied, affect my future coverage, even from a provider participating with my insurance plan?

Any insurance gurus out there who can help me figure this out?

"How often does insurance reimburse the fees? Do I kiss that check good-bye for good? "

No! Most LLMDS provide a superbill or an in-office receipt that you can submit to your insurance. My insurance allows me to go to non providers, but I have to meet a $300 deductable first, and then they pay 70% of costs they allow. Therein lies the catch.

First: Definately file that first appt. receipt. Even if you wont get any thing back THIS time. If you can meet your deductable, then you have better chance of getting something in the future. For massage or chiropractic or NP or something else that isnt fully covered.

Second: Allowable costs are different for each comapny. For instance, I paid $700 for Igenex testing. I had already met my deductable, and still only got repaid about $100.
A different scenerio:The Doc bills $400 for your first appt. and the insurance says we only cover first appointments at $100 and we will pay 70% of that. So out of $400 you get back $70.

Make sense????

Your primary concern about being denied: NO WAY! You should not be denied b/c you went out of network. They probably dont even have the ability to see that. (right hand seeing the left) If you get denied coverage, you should be able to legally do something about that. BUT>>>> You should check with them about that! Dont take my word for that one! Call them, and read your coverage book. That is my bible. I read it every once in a while to make sure I understand where I am at and how to go thru these things.

Read your coverage book! and call your 1-800 insurance godesses (wankers) and hope you get someone good. (b/c most are really something else besides GOOD!)

Hard to follow, but that is the basics. I spent almost $2,000 on my first appoint. coz of flying and such too. Maybe with the testing out of the way, you wont have to pay so much this time?? I dont recommend testng at the drop of a hat for lyme and co's. Once you get a positive then it is all about how you feel in my opinion. How you respond to treatment. Ask others here about this though.

I still submitted it to my insurance co. though. I'm hopeful. They do cover all meds from the out of network LLMD.(I have a copay of course)Mepron was $20.00 for me.

The insurance co LLMD's kinda have their hands tied. I have one and he didn't treat for babs even with a positiive test from igenex. I'm keeping him just for documentation sake.

I have empire direct hmo.

I think I've got sticker shock - this LLMD appt is a doozy - $750! Ouch! So I just had to ask!

I'm lucky enough to have 2 ins. co's covering me - so between the two, I should get *something* back. Crossing my fingers on this.

Only my secondary covers any Rx, though, so I want to make sure I don't tick 'em off right from the start. It's good to hear that yours pays for meds from the out-of-network doc, Heather - I was concerned about that, since this doc is definitely out-of-network.

So... I'll file away, and await my LLMD who does take my insurance with great anticipation...

Trails, years of dealing with this stuff qualifies you as a guru in my book - so you've just hit guru-dom, at least from my perspective! And so have you, Heather!

Thanks again, both of you. And - very cool, looming Empire image, Heather! Sums up my feelings about ins cos!

I also have a section for prescriptions. I am hoping that when tax time comes it will be very easy for me to run the numbers to determine how much I have spent on medical expenses this year.

It really puts it all together so I can see very easily what reimbursements I am still waiting on and make that call if they are taking too long. I will also go through and check what the insur co paid for with one LLMD vs. another.

I recently had to call and point out that they reimbursed me $13.60 for blood being drawn with one doctor and zero with another. I had some other issues like that they confirmed were correct. Every penny counts. My insurance also pays 80% as I am out of network with the LLMD. I haven't had too hard a time with them.

I am not as sick as some who have Lyme so I can imagine keeping track of all the bills can be very difficult for some people. It makes me wonder how much money the insur companies have made off of people too sick to keep track of what is owed to them or even able to file a claim.

First - I hear you say you're on your 3rd month of doxy. Who's prescribing that? I assume it's for Lyme?

IF you got that Lyme test from your non-LLNP done without staying OFF the abx for 10-14 days prior - it will definitely screw with your test. And a Lyme test from Quest -- that's just money down the drain IMO.

Now here's my next thought: If you can see a local LLMD that takes your insurance in August - AND you're already on abx right now -- what's your rush?

If it were me, the question that I'd have to ask myself is, is all the cr*p I'm going to have to go through (flying) and spend at the other LLMD going to be worth what it provides for me?

What are your expectations? A NEW Rx for abx? If you're herxing now - it seems the doxy is working. Just a thought.

I know & remember how confusing it is to think things through when you feel so miserable and you don't have an LLMD 'overseeing' your case. But just consider this: It's gonna be really hard for that long-distant LLMD to 'oversee' you anyway. If you were to get really sick and go to your local ER - that long distance LLMD ain't gonna do you a bit of good.

I'm not really trying to talk you out of seeing the other LLMD - I'm just trying to give you another perspective. I'm not in your body and I don't know how you feel.

I will say, though, that if you're herxing 'like crazy' - that you may want to back off the abx just a bit. It's hard for your body to deal with too much of a die off at once - and you certainly don't want to get worse with the herxing if you aren't being 'overseen' by a local LLMD.

I'm not a doctor - but if it were me - and I had some abx and was herxing bad, waiting for a new doc - I might consider just pulsing the abx I had. It would make the abx last longer, and keep me from herxing quite as bad. (I think.)

Again - just food for thought. Hang in there - you'll eventually get in to see the local LLMD!

Now Heather -- OMG woman! You'll say anything to have an excuse to put a graphic in your post, huh? That's so funny. I'll bet you sit around now and try to think of ways of connecting the content of your post with whatever pics you already have. At least it's keeping you busy, right?

Lymeindunkirk - What an inspiration you are, with your whole insurance/EOB system you've got going. I might have to try that. Insurance stuff just confuses me - especially if there are hospital charges involved. And there have been so many times that these companies try to scr*w us over because of "clerical" errors, etc. I think your system sounds AWESOME. Thanks for the idea!

Blessings,

Lymeindunkirk - what a great system - you must be waaaay more organized than I am! Actually, we used a similar system in an adoption, filing all expenses by date & category, in one gigantic folder... Don't know why I never thought about extending the system to medical bills. You offered some great ideas, thanks!

Plus, I'd forgotten about the tax issue, so that's a great reminder - thanks for that, too!

Doc Wiseass - you raised some great points. And you made me reread my post - oops, it IS confusing! The doxy is prescribed by my NP, who is adamant that I do not have Lyme, nor do I need treatment for the babesia, the doxy is for CO Tick Fever.

Perplexing, as my understanding is that CO Tick Fever is a virus, and not treatable with doxy. (Am I reading bad information on state health dept sites?)

I'm guessing that what I've experienced has been a herx (actually, maybe more like several, because I have had better periods,too) - but since she upped my dose a week ago, I've thought, "I'm dying" more times than I can count. I've since backed off the doxy, with some relief.

Your idea to pulse it till the Aug appt is great thinking - just the kind of thing I'm not doing lately! I'm walking around in the weirdest haze!

Actually, the plot has thickened for me since I posted - I saw my NP yesterday, and she's now heading off in the direction that everything is hormonal, I'm heading into menopause at 33! No Lyme, no treatment necessary for babesia, it's my ovaries. Great, all women can plan on being incapacitated by menopause, eh? Something to look forward to!

Couldn't even walk, much less pick up my baby, yet the focus of my appt became hot flashes, night sweats, and ovaries! I left her office feeling I had been relegated to the hysterical woman camp. Ugh.

Long story a little shorter - got in touch with the local LLMD (amazing!), faxed her my test results, she says I need treatment for the babesia, probably Lyme, and wants to work with my NP till my appt in Aug.

Just have to talk to my NP and see if she's open to it. It'll take some convincing!

So... Looks like I lucked out on the insurance issue, maybe, if my NP's willing to listen to the LLMD. We'll see.

Thanks for the great thoughts on this. I hope some of what I wrote made sense, I'm like a walking train wreck today, so I might just be babbling incoherently at you.

Take care, Sus