posted
So I came across something in my ever-growing research about lyme disease treatment coverage being made mandatory by insurance companies in Connecticut, including long term IV treatment if necessary!?
Has anyone else heard of this?? It was an older article from 2013 so who knows.
My question is, if anyone does know about this, if I live in NY and traveled to a doctor that was in network in Connecticut would that mean it would be mandatory for my insurance to cover it?
I am assuming not, or everyone would be fleeing to Connecticut! Figured Id see if any of you know anything about this though
Posts: 66 | From New York | Registered: Sep 2015
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- The leaders of local / state lyme support groups should know. You might contact them.
Feb. 2, 2016 -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Backing up and letting my mind really see the question, that you live in NY . . .
you ask: " if I live in NY and traveled to a doctor that was in network in Connecticut would that mean it would be mandatory for my insurance to cover it?" (end quote)
I doubt that as your insurance coverage is for you, a resident of NY state. But IF your coverage is so wide to cover doctors in other states who are in your network . . . and IF a CT doctor IN your network might actually be experienced enough to be truly LL, then . . . well, lots to figure out.
Just because there might be a law might not yet free all doctors in that state to become truly LL enough to adequately treat. The various support groups should have names, though.
There might be a question not to just if the CT doctor is allowed to treat as per ILADS guidelines but also if your insurance carrier in NY state has to recognize that right on the insurance coverage for those who are not residents of CT.
Good luck with this search. It's excellent to think of all the possible avenues. Hope the links above help. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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bcb1200
Frequent Contributor (1K+ posts)
Member # 25745
posted
I believe it is for CT residents only.
So if you live in CT and see an LLMD in CT who orders years of IV ABX,AND you have health insurance, then your insurance must pay for the IV abx.
If you don't have insurance, or if you live out of state you are out of luck.
-------------------- Bite date ? 2/10 symptoms began 5/10 dx'd, after 3 months numerous test and doctors
IgM Igenex +/CDC + + 23/25, 30, 31, 34, 41, 83/93
Currently on:
Currently at around 95% +/- most days. Posts: 3139 | From Massachusetts | Registered: May 2010
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Yeah bcb, thats what I thought, otherwise everyone would just travel to Connecticut like I said lol.
Might be worth moving to Connecticut though if this is true! haha
My insurance coverage is actually really great....until it comes to my LLMD appointments of course. They do cover treatment in other states.
I am actually traveling to Massachusetts to an infectious disease doctor who is in network. I heard they treat with IV if they feel its necessary.
I feel IV is a necessary next step for me as I am having lots of neuro symptoms and am unable to walk.
Posts: 66 | From New York | Registered: Sep 2015
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t9im
Frequent Contributor (1K+ posts)
Member # 25489
posted
It is not simple. An insurer can always cover treatment but they typically follow the IDSA treatment guidelines.
To obtain coverage approval over the standard IDSA treatment guidelines one must have a second opinion from a Board Certified MD and the MD has to be an IDSA MD, Neurologist MD or Rheumatologtist MD.
So Long Term IV is for the "neuro" lyme and is 4 months. Anything over that would require a 2nd opinion.
-------------------- Tim Posts: 1111 | From Glastonbury, CT | Registered: Apr 2010
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posted
RI laws covering Lyme treatment trumps IDSA guidelines. I was on IV for over a year with no issues with BCBS coverage. Lyme, Bart and Babs Dx codes are on all paperwork BCBS sees from my out-of-network LLMD.
Posts: 119 | From ground zero | Registered: Mar 2014
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