LymeNet Flash: Insurance is a pain

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»	LymeNet Flash » Questions and Discussion » Medical Questions » Insurance is a pain

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Author

Topic: Insurance is a pain

SpdDrv
LymeNet Contributor
Member # 5861

posted

i have been arguing with my insurance company all morning. I got an appointment with Dr. G in Houston Texas to see about my lyme disease. They said they accept all PPO insurances.
Well I called my insurance to see if he was on my PPO list or not. They told me that their PPO list was in louisiana (where I live) and if a doctor was in Louisiana I had to see them first. Well since Dr. G is a infectious disease doctor I would have to go see an infectious disease doctor in Louisiana first that they could treat lyme disease. Is lyme disease an infectious disease? I didn't think so. I tried to explain to my insurance that any doctor could treat lyme disease but that doesn't mean they "specialize' in lyme disease. I asked them if they had a lyme disease specialist in Louisiana and they put me on hold and came back and said they didn't have a listing for that but because Dr. G was a infectious disease doctor I had to see one of those on my PPO in Louisiana first.

Or I would have to pay 400 more to meet the out of network deductible and then they would only pay 60% of the fee's he charged. I was furious. I can't pay that kind of money as I haven't been able to work in over a month. Plus my family doctor is treating me for lyme disease but she has no clue about the co infection and all the other stuff that could be going on! Their network of doctor's doesn't seem as big as they make it sound like it is! I asked the woman if I got sick in Texas while visiting my Mom would i have to come back to Louisiana to see a doctor? They said that is different. I was like whatever!

There is a doctor here in central louisiana named Dr. F that wrote a book on CFS FMS and lyme disease that is being trained by DR. C (I think is his initial) in MO and I had called his office last week and the nurse had said he wasn't taking new patients.
Well I called the office back today (he is in my network) and asked if they had a recommendation of another doctor I could see about lyme disease. They suggested Dr. C in MO and Dr. G in Tx. I told her it had to be someone in Louisiana she said there was none. I explained my situation almost in tears and she said that Dr. F had given her the go ahead to take on more patients that she had three people ahead of me to call but I could see him on August 17th at the lastest but she would call me tomorrow after she called the people ahead of me and I might could see him earlier according to if the others still need to see a doctor or not but she would call me tomorrow (friday) and confirm the appointment. I was relieved as it will be easier to see someone close by.
But I am frustrated to no end with my insurance company. The good thing is now that I found a dr. in my PPO my insurance will be paying 100% because I have met my out of pocket expense for the year. I have never seen a doctor that says they treat lyme disease and there are so many kinds of doctor's that do treat it. Like Dr. G is a infectious disease doctor and the Dr. F is just a family doctor but they have taken an interest in lyme disease and learned more. My insurance didn't want to hear that they just said I could see Dr. G without seeing a doctor here inside my PPO area. I did look and Dr. G is on my extended PPO but that doesn't count they said. Talk about lyme rage I had it today! They frustrated me to no end and the sad thing is they don't realize they have been paying out the butt for me being sick the last few years and a LLMD might be able to fix that or get it better under control at least and we will know what is going on and not sticking tags on me as to what I might or might not have. I wonder what my insurance is going to say about me seeing another Family doctor knowning them they will have something to gripe about!

Posts: 220 | From Louisiana | Registered: Jun 2004 | IP: Logged |

SC
Member
Member # 5767

posted

Sorry to hear about your insurance problems. I spent about an hour on the phone with similar problems yesterday. They have tentatively agreed to approve Dr. C for us but we must have each appointment approved seprately and give them at least two weeks notice! And they do not guarantee that they will pay after we see him!
If the medical schools would actually train the doctors in the area of Lyme we would not be having this problem.

Best of wishes to you in your fight!
SC

Posts: 71 | From Indiana, USA | Registered: Jun 2004 | IP: Logged |

frenchbraid
LymeNet Contributor
Member # 4225

posted

I know it is frustrating to deal with insurance companies. But, just be glad that you have it and that you are reimbursed for any amount.

We don't have health insurance and with all four of us "Lymed", we ended up filing for bankruptcy.

frenchbraid

------------------
Stay positive. Smile. People care.

Posts: 948 | From Northwest, NJ USA | Registered: Jul 2003 | IP: Logged |

lou
Frequent Contributor (5K+ posts)
Member # 81

posted

Yes, Lyme is an infectious disease. It is caused by a bacterial INFECTION. Therefore, it is infectious.

Think you are getting infectious mixed up with contagious, a common confusion.

Posts: 8430 | From Not available | Registered: Oct 2000 | IP: Logged |

dmcbrayer
LymeNet Contributor
Member # 5296

posted

Insurance companies always bragg about how many medical benefits they offer and how flexible their plans are.

Then we get sick, and then we know the real truth.

DMC

Posts: 221 | From fort smith, arkansas, usa | Registered: Feb 2004 | IP: Logged |

panther
Member
Member # 5348

posted

Hey, you guys should count your lucky stars. Although my local internist is very good about working with my LLMD (who is far away in NYC area), my actual consults with the LLMD are not covered at all, which is a huge expense. I've thought of switching to Dr. C in MO, which is much closer, but I really like the guy I have, he's a brilliant genius and I need someone who is able to defend me against the depredations of other specialists I see, including some in academia, for a couple of other medical problems I have.

quote:
Originally posted by dmcbrayer:
Insurance companies always bragg about how many medical benefits they offer and how flexible their plans are.
Then we get sick, and then we know the real truth.
DMC

Posts: 45 | From Stillwater, OK, USA | Registered: Feb 2004 | IP: Logged |

Tincup
Honored Contributor (10K+ posts)
Member # 5829

posted

Baseball bat for sale- cheap

Only used 87 times on ducks...

OR...

May I suggest...

If you are stuck in this position again.. go ahead and go to the duck if you must... but first...

Make an appointment with a LLMD before hand so you have a date set up.

Then....

Make an appointment with the duck of their choice.

When you go to the duck appointment..

Have IN HAND a list of what you need (test wise) and some complicated medical "stuff".. and a complete symptom list.... and as soon as they walk in the room and say their first quack greeting..

Kindly say ..

"Hi doctor. My insurance company is MAKING me come here to you FIRST to get a referral to a doctor out of state who will be treating me for Lyme disease and co-infections. My appointment is next week and I just need a referral and I will be on my way. Thank you."

That way they know EXACTLY why you are there.. you don't plan to involve them.. and.. as rude as it may be... they usually try to get rid of you when they hear the word "Lyme disease" anyhow.

If they try to question you at all or trip you up... just reply, "I don't know. I have to ask MY doctor about it."

I know this process can be frustrating and painful.. especially when you are sick. Try to hang on... and if needed... play their stupid game. They will get STUCK with TWO bills because of this foolishness... and will EVENTUALLY get the message that their policy is costing them MORE money doing it this way.

It may not help you at the present time.. but the next person who is in this position may find it easier to get help.

You did real good and I am happy you didn't throw in the towel.... and I have a strong feeling you will win.

Keep up the good work.

And remember Plan B... just in case.

Baseball bat for sale... real cheap.

Posts: 20353 | From The Moon | Registered: Jun 2004 | IP: Logged |

Lishs mom
Frequent Contributor (1K+ posts)
Member # 2344

posted

quote:
Originally posted by SpdDrv:
i have been arguing with my insurance company all morning. I got an appointment with Dr. G in Houston Texas to see about my lyme disease. They said they accept all PPO insurances.
Well I called my insurance to see if he was on my PPO list or not. They told me that their PPO list was in louisiana (where I live) and if a doctor was in Louisiana I had to see them first. !

Write to every infectious disease doctor in your area.Tell them,you have late chronic lyme and ask
1) Do you treat late stage chronic lyme with long term antibiotic.
If no, ask if they would please treat you with long term antibiotics (3+months)
If they say no, ask them to send a letter refusing to see you.

If all the docs in your area "refuse" to see you, then you can go out of state!

Posts: 1918 | From Central, Oregon | Registered: Apr 2002 | IP: Logged |

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