posted
My company medical insurance has been pretty good about playing along with my Lyme IVs and Rx medications to this point. Today, I got my first "these meds are not approved" letter for my 2 week course of IV Invanz. They want to deny payment. Obviously, I'm going to appeal their call. I'd appreciate any letter writing tips about politely tossing the rock back their way. I've been on the policy for 12 years.
Thanks, GM
Posts: 135 | From Orlando, Florida | Registered: Feb 2009
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dmc
Frequent Contributor (1K+ posts)
Member # 5102
posted
I'm not great at writing. I think th doctor who RXd it should be the one to explain it's medically neccessary.
Posts: 2675 | From ct, usa | Registered: Jan 2004
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dmc
Frequent Contributor (1K+ posts)
Member # 5102
posted
up for others imput
Posts: 2675 | From ct, usa | Registered: Jan 2004
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posted
CALDA (Calif Lyme Disease Assoc) has a great form letter you can download for those appealing to insurance companies.
-------------------- IV graduate. As of 1/10, oral Omnicef, Minocyline, Mycobutin, Levaquin, and Flagyl. Lyrica and a bunch of supplements. Posts: 123 | From Atlanta | Registered: Mar 2009
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
My LLMD has taken care of denial for me in the past. The office knows all the technical jargon and is much better at justifying things than I am.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
This is good to know... I am thinking I will get one of those letters ....
And i was not sure how it can be handled..
So the doctors office is willing to and will take care of those denials for us??
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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posted
I called my LLMD's receptionist. His staff said to have the insurance company's doctor call him. I called the insurance company doctor, his CSR said she'd pass along the request. Meanwhile my IV line is switched off due to the insurance paperwork roundy-round.
Posts: 135 | From Orlando, Florida | Registered: Feb 2009
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-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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seekhelp
Frequent Contributor (5K+ posts)
Member # 15067
posted
Do your LLMDs charge big bucks to perform this task? I mean trying to get insurance to pay for things they initially decline. Or is it a built-in service to the already big price tag paid?
Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008
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posted
I don't believe that LLMD charged me to call my insurance company doctor. He does charge for filling out long insurance / disability forms. (I really can't blame him for that.) Billable time, working is billable time. I guess I can't complain about my insurer, they've only question my treatment protocols once in 8 months.
Posts: 135 | From Orlando, Florida | Registered: Feb 2009
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