LymeNet Flash: Health Insurance Question

LymeNet on Facebook

LymeNet on Twitter

Follow @LymeDiseaseNet

The Lyme Disease Network receives a commission from Amazon.com for each purchase originating from this site.

When purchasing from Amazon.com, please
click here first.

Thank you.

Dedicated to the Bachmann Family

LymeNet needs your help:
LymeNet 2020 fund drive

The Lyme Disease Network is a non-profit organization funded by individual donations.

»	LymeNet Flash » Questions and Discussion » Medical Questions » Health Insurance Question

UBBFriend: Email this page to someone!

Author

Topic: Health Insurance Question

allegra
Junior Member
Member # 21902

posted

It is time to choose health insurance for the coming fiscal year.

I have always had an HMO, which has not covered my LLMD visits.

I am now thinking of a PPO. The info sheet states that after the patient's coinsurance and a deductible, they will pay in full up to a reasonable charge for covered services.

The patient may also be responsible for paying any difference between what the plan covers and what an out-of network provider charges for a service.

Since LLMDs are so expensive, I am wondering if the PPO will refuse to pay the usual percentage for a visit and will pay a much smaller percentage based on the fact that the fee is "unreasonable" or pay nothing at all as the plan may not cover chronic lyme treatment.

Has anyone had experience with PPOs and LLMDs? I know that I would submit the bills to the insurance company as the LLMDs don't deal with insurance companies.

Posts: 5 | From MA | Registered: Aug 2009 | IP: Logged |

TF
Frequent Contributor (5K+ posts)
Member # 14183

posted

Yes, I had a PPO when I was treating lyme. Probably the largest PPO in the nation.

The PPO will have an amount that they consider reasonable for each lyme doc visit. They will pay their part of that "reasonable" amount, and you will be responsible for the rest.

So, it likely will depend on your lyme doc's credentials how much they will pay. If he is a GP or an internist, they will likely allow a lesser amount for each visit that if he is some type of specialist (which is the less likely alternative).

My PPO paid with no problem. They didn't deny payment because the diagnosis was lyme. They paid a small amount of each visit, and they covered the meds like they would for any other disease.

They covered Igenex tests and all other tests as they would for any other disease. What they allowed for Igenex was a low amount. I think they reimbursed me for about 1/3 of my costs there.

I submitted bills for 13 months. Before that, I went to lyme docs who took insurance. That was another 2 years of insurance reimbursement.

Posts: 9931 | From Maryland | Registered: Dec 2007 | IP: Logged |

Printer-friendly view of this topic

The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:

The Lyme Disease Network of New Jersey
907 Pebble Creek Court, Pennington, NJ 08534 USA
http://www.lymenet.org/