The NP called and said she did not know I was a medicare patient. She said the government does not recognize NPs as doctors. Not only will they not cover anything, they will not allow any lab to do tests prescribed by an NP even if I pay for it myself!
She said Labcore will probably kick those tests back and not do them. Quest refused to do the ones I took into them. If I had known I would not have shown them my medicare card. I would have lied about my age.
I don't know what to do. This is so frustrating. I have spent so much money and it has all been for nothing.
Posted by GretaM (Member # 40917) on :
Posted by randibear (Member # 11290) on :
Thats exactly why I am keeping my private bc/bs when I go on medicare. I go to the doctor alot and I dont care what my husband says.
The government is going to screw us anyway but I want to make sure im covered.
Posted by nefferdun (Member # 20157) on :
It is not just about being covered. You are not allowed to pay for it yourself! Why?!
Posted by Lymetoo (Member # 743) on :
I've heard that before and it makes no sense. I guess it is the government's way of controlling us. More of that to come.
Neffer .. I'm so sorry that you've had one more brick wall. I hope someone here has an answer for you.
Posted by TF (Member # 14183) on :
You are not allowed to pay for it yourself if you have bought Medicare Part B (the doctor's insurance which also includes tests, outpatient, etc.). That is because of what the Medicare law says.
The Medicare law says that it is illegal for anyone (doctor, lab, etc.) to charge a Medicare Part B patient for any treatment, test, etc. unless they submit the charge to Medicare and accept the Medicare payment amount. It is illegal to do otherwise.
The only way around this, according to the law, is if the provider (physician or lab, etc.) has "opted out" of Medicare.
This is a paper that they submit to the Medicare agency saying that they will not participate in Medicare. This puts them 100% outside the system. (That means that nearly all Medicare patients will NOT go to that provider.)
Then, if they want to take a Medicare patient, they are free to charge the patient whatever they want and the patient or doctor cannot submit any claim to Medicare, but the doctor or other provider must advise the Medicare patient in writing BEFORE they provide any service that they have opted out of Medicare AND the Medicare patient has to sign the paper saying that they understand what this means and that they understand that they CANNOT submit any of the provider's charges to Medicare for reimbursement. And, the patient must be given a copy of this notice.
This puts the Medicare patient on notice that this provider does not participate in Medicare and the patient will be 100% responsible for the bill.
These rules were put in the Medicare law years ago so that providers could not charge Medicare patients more than Medicare allows them to charge.
The only way to charge more is to opt out of Medicare completely, which few providers can afford to do.
So, you have 2 choices: you can only go to providers who have opted out of Medicare (some lyme doctors have opted out, but I don't know of any labs or hospitals that have), or you have to decline/terminate your Medicare Part B coverage.
If you do either of these, then the Medicare rules will not apply to your relationship with the provider.
I intend to decline Medicare Part B when I turn 65 due to these rules. I will keep my private insurance.
Posted by seibertneurolyme (Member # 6416) on :
Nefferdun,
Your other option would be to order the lab tests online. I know Life Extension for example offers discounted tests and does not file with medicare or insurance and the patient or person requesting the tests agrees that they will pay for the tests themselves and not file with either medicare or insurance.
Pretty sure most of the other online labs except Quest and LabCorp operate the same way.
Bea Seibert
Posted by Judie (Member # 38323) on :
Is there an MD (or LLMD) that the NP works with that can help?
Does the NP work out of a doctor's office (even at a different location)?
If they do, they write up the lab slip as if it's coming from the doc because the NP is suppose to be practicing UNDER the doc and the doc is overseeing them.
I've had plenty of tests covered by medicare that an NP or ND has ordered by having the slip come from the MDs office.
Posted by Catgirl (Member # 31149) on :
So sorry to hear this Neff.
TF is so good at logically explaining stuff. Thanks TF! Posted by Robin123 (Member # 9197) on :
Ditto what Judie's saying - can the NP make an arrangement with an MD to cover the Rxing?
Posted by canefan17 (Member # 22149) on :
Enter DISCOUNT10 for 10% off (special running right now)
Posted by daphnesmom1 (Member # 39433) on :
So sorry to hear about this nefferdun. So ridiculous things have to be this way for us.
Some good suggestions here, I hope it works out.
Posted by nefferdun (Member # 20157) on :
You guys are amazing. Thanks TF for such a thorough explanation . Dr. F said the new medicare rules under Obamacare are even worse.
I have had a few heart twinges of pain and the NP told me to get an EKG. There is a family history of heart disease and stroke so they should run relevant tests. Plus I have a history of radiation to my head which can cause thyroid cancer and brain tumors. With my brain fog and headaches, I should qualify for a brain scan.
I will go to a local doctor and get as much of this testing done as I can and then drop the part B plan and get private insurance if I can. I will have to find out if I can get on BC/BS, which my husband is on (he is younger than me).
The NP does not work with any MD. I spoke with her and she did not recommend anyone. I will check into the labs recommended (I got a PM too). If they are not affiliated with Medicare then she could write me another script. The problem is getting my blood drawn. I think I should just get rid of this medicare. I had no idea.
You have all been so helpful. Thanks so much.
Posted by poppy (Member # 5355) on :
The trouble is that people who have medicare and a gap plan end up paying almost nothing, so without medicare you will have all those confusing copays, coinsurance, etc. Should a major operation be involved, then you would be looking at whatever the catastrophic limit is. These days, just a few days in the hospital, even without an operation, can break the bank.
It is puzzling that some states allow NPs to practice alone, but fed rules do not recognize this. What will they do in future with the doctor shortage if they don't allow other types of practitioners to get involved? Stories in the media keep saying that is going to be the answer to doc shortage.
Posted by nefferdun (Member # 20157) on :
canfan, I think I see what you mean now. It says I do not need a doctors orders. You think I can just buy it and take it to a lab and they will draw draw the blood? I am going to try it and see what happens.
Posted by nefferdun (Member # 20157) on :
I made an appointment with a physicians assistant at a clinic a friend recommended. I will not tell them I ever had/have lyme disease. I will just tell them my symptoms, previous history, blood test results and family history.
I'll wait and see what happens. In the meantime I have the drugs I need. The NP just needs some testing done by next month. I will get the results of the tests the ID doctor did and send them to her.
I also set up an appointment to get the Galaxy test for one of the cats.
Yeah poppy, with my luck if I dropped medicare I really would have a heart attack or get cancer or something.
Posted by TF (Member # 14183) on :
Regarding being an in-patient at a hospital, that bill is covered by Medicare Part A (hospital insurance) which is free.
So, be sure you keep your Medicare Part A insurance if you drop Part B (which you pay for monthly). This way, if you are admitted to a hospital, your free Medicare Part A will cover a lot of your bill.
If you go on Blue Cross/Blue Shield, they will likely pick up the hospital charges that the Medicare Part A insurance doesn't cover.
Of course, Part A has rules also. Someone recently said that the hospital kept them over night "for observation" and for that reason Medicare Part A refused to pay the bill. You have to be admitted to the hospital for Medicare Part A to pay, they said.
But still, if you have Blue Cross/Blue Shield and then Medicare Part A, you will have good coverage.
Posted by nefferdun (Member # 20157) on :
Thank you TF. I was looking up how to drop the Part B. You are automatically enrolled in it and they make it very hard for you to un-enroll.
Do you have any ideas of the best insurance company for getting coverage for Lyme?
Posted by Abxnomore (Member # 18936) on :
Keep in mind that in most cases if you should want Part B later down the line you will pay more for it because a penalty is imposed.
Be sure to ask about the time frame in which you can re-enroll in Part B without penalty and what the penalty will cost you, should you choose to enroll later on.
Posted by Judie (Member # 38323) on :
Be careful about dropping medicare. I hear it's hard to get back on if you opt out.
You might want to look at a supplemental plan instead for next year.
I took my husband's insurance this year and dropped medicare part D. WORST DECISION!
His insurance won't cover my bicillin LA shots in any setting, BUT medicare Part B may cover part of it in a clinic setting.
"Do you have any ideas of the best insurance company for getting coverage for Lyme?"
Medicare actually covers a lot of Lyme treatment. There are some great Part D plans.
Other insurance may NOT cover the tests that you want to get either. At least the lab will tell you upfront if medicare will cover part of them.
You can get stuck with a hefty, unexpected bill will other insurance.
Posted by lax mom (Member # 38743) on :
I have had a Medicare Advantage PPO plan for a few years and have been very happy with it. I have had several surgeries, my oral Lyme meds and Bicillin has been covered and all of my labs and tests have been covered.
When 1 med wasn't covered long-term, I filed an appeal and immediately won.
If your income is low to moderate, you can qualify for extra help with prescriptions and pay very little for copays.
If you ever choose a Medicare Advantage Plan, DO NOT choose a PFFS nor HMO plan.
Posted by TF (Member # 14183) on :
Employees in doctors' offices have remarked over the years to me that Blue Cross/Blue Shield is "the best."
Posted by LisaK (Member # 41384) on :
anyone can have tests done on their own. I have done it. It was humorous to see the look on the lab techs' faces when they asked who ordered the test and I said, "I did".
That is funny Lisa. Thanks for that link. I will look at it. The site Canfan gave me is great. The prices are very reasonable (cheap actually) and I can get the tests without a doctors order. I was worried who would draw the blood because there is no LabCore here but the local hospital will do it for $45. Then I have to pay to overnight ship it.
I can do that. If I had gone to a LLMD instead of an LLND, I probably would not have had a problem. The best idea wold probably be to change doctors.
At this point I feel like I would have done better to just treat myself. I was worried about taking drugs without getting liver and kidney tests.
It is ironic the doctor I chose could not prescribe those tests for me anyway and she prescribed the same drug I bought myself from India. I am still taking that drug - I haven't gotten the script she gave me filled yet.
Every time I have gone to an LLMD they have confirmed my diagnosis and given me what I wanted to take, so I have been treating myself all along. My biggest concern is are Indian drugs safe? I am taking LipoPhos EDTA almost every day so if there are heavy metals in those drugs, I would be removing it immediately.
This LLND is extremely expensive. I paid $1000 for a bag of supplements, most of which I have used before and did not find effective. I have to have a call with her every month for about $350 and visit 3 times a year. If I followed her complete protocol buying all her supplements and flying there 3 times a year, plus all the calls, the cost would be out of sight. Is it really this expensive to get well?
I go from wanting to believe there is a doctor out there that is going to have the cure for what I have and get me completely well, to thinking I am wasting my time and money and can do this just as well myself.
When I couldn't get the tests done I began looking up what they are. 90% of the population has the Epstein Bar virus. If you ever had mononucleosis, you have it. I had mono so I don't need that test. What do they do for viruses anyway?
These doctors test for everything under the sun to protect themselves. As the NP said, it is very dangerous for them to treat Lyme. They need to keep very good records and have a lot of testing to prove they are not just dispensing drugs.
The last LLMD I saw did the same thing. He insisted I pay for a test for RA even though I had no joint pain at all. The one good things he did was discover antibodies against my thyroid. That LLMD did not believe an ANY supplements AT ALL. I had been taking massive amounts and I just quit. He was one of the guru's of lyme, one we are all familiar with.
So it is all over the place what these doctors are doing as far as tests and supplements. I have a pretty good grip on what actually works for me. I am thinking I need another doctor rather than drop medicare and in the meantime I will just treat myself.
Posted by 2roads (Member # 4409) on :
Sorry you are dealing with this Neff.
Posted by Rumigirl (Member # 15091) on :
Oh, neff, what a mess! Medicare is unbelievably convoluted as far as I can tell. For that reason, and other reasons, I've steered clear of it---for better and worse (both, I think).
If you do work with the dr (NP?) again, you certainly don't have to buy the supplements from them. You can shop around and get them elsewhere, undoubtedly much cheaper. I almost never bought any from any docs, and always got them elsewhere.
Surely, you are right that you know as much as the doc/NP. The one caveat though, as you mentioned, is monitoring your blood levels. Unless you simply do that yourself, too.
Sigh. It shouldn't be so hard----but it is.
Posted by nefferdun (Member # 20157) on :
Thanks. I have an appointment tomorrow to hopefully get some blood work for high ferritin, hyper coagulation (thrombin antithrombin) and maybe some of the other tests results that were high last time I was tested in 2012.
I won't even mention Lyme disease. They should test me to be sure I don't have a brain tumor or heart disease or coagulated blood. I had radiation as a child which raises my risks of thyroid cancer and brain tumors. As muddled as my mind is and as many headaches as I get, they should check for that. I hope I don't have lesions on my brain but if I do, I need to really get serious.
Posted by Rumigirl (Member # 15091) on :
I hate to say it, my doc last May said, "When was the last time you had a brain MRI?" (I have had horrific migraines and brain pressure for decades). I hadn't had one since Dec. '06, in spite of the fact the that one and a previous one found lesions that looked like MS.
When I got the results in July, I started yelling. I now have 40-50 lesion PER HEMISPHERE!!! And plaque everywhere in my brain. "Severe disease burden." the report said. I really freaked out.
Well, I was already serious and trying to be aggressive with my treatment, but this really put the fear of God in me to switch docs and "step on the gas."
I also have too many symptoms that are surely from the CNS damage for which there is no fix.
That's a very long way around saying, get a brain MRI! And make sure that they do it with contrast (that has to be on the rx). That way you will know if any lesions are old or current. We didn't do that, as neither my doc, nor I knew to do that.
This stuff is horrifying. This was after years of treating as much as I could, but constantly running into treatment obstacles and docs who wouldn't give me what I need, such as flagyl or
tinidazole. And I push like he%% to get what I need (nicely, of course). If I make it out of this mess even somewhat better, it will be a major miracle.
Yeah, you definitely need to make sure that you don't have a brain tumor! We lost a close friend to that last year, and lost my brother-in-law to it 11 years ago. Awful. We'll pray that it comes out clear.
Posted by nefferdun (Member # 20157) on :
Thanks Rumi, I am glad I found your post before the appointment. I just hope I don't have to threaten this physicians assistant (that was all they had available) to do the tests. I am so at the end of my rope.
I keep telling myself they can't ignore my symptoms with my history and my family history - BUT they can do whatever they want.
My cognition really is a mess. I hope I don't have lesions all over my brain but I wouldn't be surprised if I did. I have to carefully read over everything I write - several times - because I make so many mistakes. I can't remember things. It is hard for me to calculate anything.
One of the worst things is trying to follow a new diet, which I have been doing for two years now, but I still can't think of what to make when it is time to cook dinner because those new memory links just don't happen.
I have to put really large notes up to remember when to do something. A small note on the frig just won't do. I write it on the paper towels and then pull it down so it is a big sign.
I don't want to have dementia - so scary.
Posted by nefferdun (Member # 20157) on :
I don't know if other people do this but I have picked up the TV controller trying to call someone or tried to use the telephone to change the channel.
I found the lunchmeat treats for the dogs in the drawer instead of the refrigerator.
Our diabetic cat gets shots twice a day. I have to keep everything in a box. On one side it says, "did AM" and on the other side it says"did PM". This is because literally ten minutes after giving the shot I can't remember if I did it. I have absolutely no recollection.
Drives me crazy.
Posted by nefferdun (Member # 20157) on :
She was very nice and ordered an Brain MRI and heart stress test. She is teasing my ferritin levels. The only thing she didn't do was thrombin-antithrombin for hyper coagulation. She said if I have that it is genetic.
Funny, you tell someone how you feel without mentioning anything about lyme disease and they are very concerned. You tell someone you have treated lyme and they just want to get you out of the office. So I didn't mention it. After all, the ID doctor said I never had it.
She gave me something to try to control my headaches so I don't have to take Imetrex all the time.
Posted by Judie (Member # 38323) on :
"She said if I have that it is genetic."
And if it's genetic, you WANT to get treated so the meds can penetrate.
I'm taking boluoke, and we're seeing if I need something stronger or weaker depending on the levels.
[ 02-25-2014, 08:04 PM: Message edited by: Judie ]
Posted by nefferdun (Member # 20157) on :
I remember reading that. In fact i got heparin shots because of what he said. I took them for about ten days. They really hurt and I had bruises for a year.
I read heparin can leach calcium out of the bones. Even some young women taking it can develop osteoporosis. I don't think it is as safe as he says it is.
He is right about infections making it worse. I have done everything I can to lower it. The doctor had never even heard of the thrombin antithrombin test.
According to Dr. S boluoke does not affect biofilm because it works on protein and biofilm does not have protein. It thins the blood but works very slowly. I took it for two years and then F Labs said I had substantial biofilm. So I switched to the EDTA.
Posted by lyme in Putnam (Member # 11561) on :
I hope things work out for you.
Posted by Judie (Member # 38323) on :
I got my 23andme results and for me it's not genetic.
I'm just taking boluoke for hypercoagulation, not biofilm.
Hypercoagulation is causing all kinds of other problems for me like slow healing, high blood pressure, the list goes on and on.
![[Frown]](frown.gif)
![[Smile]](smile.gif)
![[group hug]](graemlins/grouphug.gif)