posted
So our insurance denial for IV abx cites not having a positive "western bloc" as part of the reason for denial.
Is there such a thing or are they meaning western blot?
If this is a typo (it appeared in two separate letters) how in the world can I even be sure they have any clue what is medically necessary for tx?
I'm still appealing, and my DH isn't interested in a spinal tap to prove. He definitely needs IV to treat the unidentifiable mass in his brain (well the neurosurgeon thought it was a Glioma, but feels it is worth it to take the IV abx route).
In all of your experience, what has been successful in arguing treatment necessity? Any advice will be appreciated.
Posts: 274 | From United States | Registered: Feb 2012
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Typo based on ignorance. One letter probably copied that from another. No one knows enough about lyme tests to correct it.
But, seems the Western Blot was still negative, regardless of their typo.
If they are wrong, though, and you have the results showing it was positive, that's worth something.
Sometimes, though, IDSA doctors also require a positive spinal tap in addition to positive IgG Western Blot (and some even want to see a current bulls eye rash, too).
A spinal tap is not likely going to prove lyme, anyway. Unless you are very lucky. Better chance at winning a bit lottery.
A spinal tap will likely be negative for lyme and then - even if another positive test comes along later from a good lab - it will never be allowed for diagnostics.
A spinal tap is an unwarranted expense, too, and can cause pain and suffering for some time afterward for some (not all).
I could not argue and win - and just had to go my own way- far away from the "medical model" that has been so disengaged about lyme.
If you have to fight a doctor to care for you, you have the wrong doctor.
A lyme dx might only get you 30 days of IV antibiotic, anyway. Any chance IV abx could be a treatment for his other diagnosis?
Has he been tested for other TBD? You may be able to cover two birds with one stone if there is another diagnosis for which the same Rx to treat that would also cover lyme. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
Many with lyme also have Cpn. Treatment is very similar. If you can't find a doctor to treat lyme, you may be able to find one to assess chronic Cpn. Be aware, though that as with lyme, not all doctors "believe" in chronic Cpn. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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posted
Yes, W. Blot was negative based on IDSA guidelines. I think there were three positive bands. LLMD recommends another test to see if we can get anything out of it.
I'll have to look back at records to see if there was anything that was a definitive positive test. He is treating Babesia and Bartonella, too.
Keebler, I'd probably rather win the lottery than have him get a spinal tap, too. I've heard that they are risky at best and not conclusive. At least if we won the lottery we'd be able to cover the cost of IV medication!
Luckily both our LLMD and a non LL neurosurgeon are supportive of IV abx for treatment. It's just a matter of getting it covered insurance wise.
I'm worried we might be losing precious time while he goes untreated and we appeal the insurance company.
LLMD recommends we start treatment without coverage, but we've already invested all of our savings and any extra money in appropriately treating the whole family so we are kind of in a sticky situation. We can't really afford to go deeper into CC debt and have no equity in our home since we recently purchased it.
Of course, money shouldn't matter when it comes to situations like this, but only the wealthy can truly say that.
Posts: 274 | From United States | Registered: Feb 2012
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posted
OMG, Lymetoo - it was a LabCorp test, not Igenex.
We had this one done with a previous "LL"MD and hadn't had a problem being treated so never really looked into it further. All this time, I had thought it was an Igenex test.
I suspect the next plan of action is to get an Igenex W. Blot and see if we can't get ourselves a positive test result. Right?
Posts: 274 | From United States | Registered: Feb 2012
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