My husband and I are changing health insurances and I need to know ASAP anyone's experience with the two options available to us:
United Health Care PPO (through definity) Blue Cross Blue Shield PPO
Other than my current HMO (which is horrible), those are the only plans available to us. I need to know this info ASAP about people's experience with their treatment of lyme, i.e. meds, etc etc.... My husband just dropped a bomb on me and told me the change needs to be done by this wednessday morning.
If you have any info, please email me or send me a private message.
Thanks so much, Nancy
Posted by lyme_suz (Member # 7628) on :
We have found our blue cross blue shield to be excellant.
My husband asks them tons of questions-can you get info from them? Check websites.
One awesome thing with BC is that a lyme specialist and other good drs are on plan for $10 co-pay.
Wish I knew more, good luck.
Posted by lou (Member # 81) on :
Different BX state plans vary a lot in their lyme coverage. NC may be good, but I haven't heard anything good about BX in NY. Might do a search of the legal resources section of this website, seems to me there have been lawsuits against BX in NY for poor lyme coverage. If not in the legal resources, there have definitely been problems. Have you asked this question of NY support groups?
I don't know anything about united health.
Posted by aiden424 (Member # 7633) on :
I have Blue Cross as primary and medicare as secondary. I have had no problems with either of them covering medical expenses. Kathy
United Health Care PPO (through definity) Blue Cross Blue Shield PPO
Posted by lymex5&counting (Member # 7202) on :
I PM'd you with our BCBS PPO experiences.
Posted by SForsgren (Member # 7686) on :
UHC PPO has been good for me. Aetna su*ks....
Posted by docjen (Member # 7510) on :
I had BC/BS PPO and it did not cover a single cent of any of my lyme tx, including tests and doctor's visits. They did cover SOME drugs. I fought like a dog on the phone with them, and I got nothing but the run-around (resubmit, and resubmit, and resubmit....). I know BC/BS plans are all different, but my experience was THE WORST.
Posted by Jillybean (Member # 8071) on :
What you're up against now is a "pre-existing condition". They may very well exclude any/all lyme treatment whatsoever.
This happened with my husbands hip situation. He has Avascular Neucrosis(a dead bone disease). Had a titanium ball put in, but since he's only 45 they know it will have to be replaced.
So they excluded anything related to the hip in our new policy. And we have Aetna, which really stinks, because they just came out with all the exclusions for lyme (new or old diagnosis).
Good luck to you, but you might want to check first....your present insurance might not be so bad after all.
Jill
Posted by Andie333 (Member # 7370) on :
I'm in PA and have BC/BS PPO.
I pay through the nose for it (more than $500 a month). My LLMD is out of network. I had to first meet a deductible for her, and then they compensated 60%.
Meds (after deduct) are 60% too, I think, provided they're generic.
So far, nothing has been challenged by them or questioned.
I wish you a lot of success finding a plan that works well for you and your family!
Andie
Posted by Boomerang (Member # 7979) on :
We have BCBS of TN. Went to doctor in Missouri. BCBS covered approx 1/2 the doctor bill, since we went to an out of network doctor.
Prescriptions so far have been paid......with the usual $10 copay.
Good luck!
Posted by duke77 (Member # 5051) on :
quote:UHC PPO has been good for me. Aetna su*ks....
Ditto
Posted by lhm312 (Member # 3147) on :
I had UHC when I lived in NY and wouldn't think of switching. No insurance company is perfect, but I have to say they were very good to me.
PM sent, please check.
Posted by chroniccosmic (Member # 7789) on :
I have UHC in IL and haven't had any real problems. Even the Missouri docs that are out of network are partially reimbursed. My plan even allows 500 annual for chiropractic/acupuncture. No complaints.
Posted by Susan in G'ville (Member # 8185) on :
You may need to stay on the plan you have now because, I'd imagine that most ins urance companies have a "pre-existing condition" clause. You might not be told up front that it wouldn't be covered, but I imagine that if you asked a specific enough question, you'd get a real answer.
Good luck.
Posted by intoxincated (Member # 8248) on :
there is a new law prohibiting them for not covering preexisting conditions. UHC PPO is 100 times better than my HMO, which is gonna put me and my husband in debt. I am going to consult a health advocate about this, but as far as I know, insurances are not allowed to exclude pre-existing.
Posted by lymedad (Member # 8074) on :
Our daughter has UHC and they have been excellent to this point. Their maximum allowables are a little stingy, but they have not balked at paying to their limit.
I have not been able to find anything about UHC and their total LD maximums. Their website has a fairly decent section on LD, but the pages concerning total coverages are mysteriously blank.
Posted by intoxincated (Member # 8248) on :
I'd love to find out what you mean by stingy allowances.
Also, to be specific about pre-existing conditions (I have worked in health care for several years:
Previously, health care given for a pre-existing condition often was not covered for someone who joins a new plan until after a waiting period. However, under the new HIPPA law, effective as of July 1, 1997,
"A pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre-existing condition will be covered--without additional waiting periods--even if you have a chronic illness. If you have a pre-existing condition and have not been insured the previous 12 months before joining a new plan, the longest you will have to wait before you are covered for that condition is 12 months"
Good news to all of us who have preexisting conditions and have had continous health care with no lapses.
Posted by burnbitter (Member # 7088) on :
blue cross or blue cross blue shield vary greatly by state. GREATLY. Not that they are never not a pain in the *** with many tricks on how to delay payment as long as possible, but some of them are less bad about it than others.
Posted by lymedad (Member # 8074) on :
Intoxincated:
Stingy may have been a little harsh. I don't mean to sound ungrateful.
We're very pleased to be getting any help and no amount of money would be too much. The plan is a PPO and this bill was for "out-of-network" doctor.
This was the first office consultation with our LLMD. Money well spent!!!
Date of Serv 09/27/2005
Total Charge $450.00 Patient Pay $330.54 Insurance Pay $119.46
Posted by tidegal (Member # 8262) on :
I have both UHC and BCBS PPO. BCBS PPO has paid for everything and I am on IV abx for 5 months. UHC will only cover IV abx for 28 days, so make sure you take that in to consideration. I was lucky, if I hadn't had the BCBS PPO, I would be stuck with about $50,000 worth of IV med bills so far. Please, please call both plans and ask what they cover before you decide. It is SO expensive to get treatment and the last thing you need is a whopper of a dr bill on top of everything else.
Take care, tidegal
Posted by lou (Member # 81) on :
I think states with a lot of lyme cases are more likely to have insurance cos with restrictive policies. That is why there is such variation between states in the BX system.
Since you are in NY, the situation there is most relevant. Here is an excerpt from an older newsletter article that I have scanned in. It is based on the New York Law Journal article on the same subject. If it is not already too late for your decision, I will try to scan that in also, fyi. Think there might be more than one BX outfit in NY. This article is about Empire BX. But isn't Anthem BX there also? They probably have similar lyme policies.
Anyway, here is the article about a Lyme court case in NY:
"In late 2000, a New York appellate court ruled against a group of Lyme patients who were suing Empire Blue Cross and Blue Shield for denying intravenous (IV) antibiotic treatment. The patients were asking for punitive damages based on "tortious conduct" during the period from 1993 to 1996. In 1993 Empire Blue Cross began requiring preapproval of Lyme disease treatment and limiting IV treatment as part of their new medical necessity standard for the disease.
Although the judges did not rule out breach of contract, punitive damages are excluded as a result of their decision on this case. Their ruling said that it was reasonable to update the company's medical necessity standards based on "the latest research and findings within the medical community concerning what is appropriate treatment for a given medical condition."
Expert witnesses for the insurance company included Ray Dattwyler, Thomas Rush, Eugene Shapiro, Gordon Moore, and Eric Logigian. The first three are also co-authors of the recently released guidelines for Lyme disease treatment formulated by the Infectious Diseases Society of America. Dr. Alien Steere was also a co-author. These guidelines say that the efficacy of long-term treatment for chronic Lyme disease has not been proven. Dr. Logigian was a co-author of the infamous Steere article on the "overtreatment" of Lyme disease.
Contributing to the poor outcome of this case is Dr. Alien Steere's authorship of most of the Lyme disease chapters in medical reference books. Also, the research funding that goes inordinately to his school of thought has produced many published articles. As a result, it is easy for insurance companies to compile a supportive bibliography."