Foggy
Frequent Contributor (1K+ posts)
Member # 1584
posted
Tin, what's up with all the polls? You running for office?
I'm happy to buy a pencil from your "tincup" but my incalculable "lost income" went towards my treatment for countless MDs that my insurance co wouldn't pay for. <>
What happened to your class action lawsuit from '01?
[This message has been edited by Foggy (edited 28 February 2005).]
Posts: 2451 | From Lyme Central | Registered: Aug 2001
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posted
They wouldn't pay for my Bicillin. I was out about $800-1000 before I changed abx. Other than that they've covered pretty well.
Posts: 635 | From Texas | Registered: Mar 2004
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posted
The only major problem I've had with my insurance company is finding adequate "in-network" providers which they will pay at 100%. Most of the LLMD's are out of network and also the infusion service which I get my IV abx is out of network, but they will still pay 60%. My insurance also has an annual out of pocket max of $8,000.00, which was a saving grace last year.
Posts: 9 | From Frederick, Maryland, USA | Registered: Jun 2003
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JillF
Frequent Contributor (1K+ posts)
Member # 5553
posted
I have not even tried to get insurance to pay. I know they are too cheap.
They will pay for my medication but that's it.
So it's out of pocket for the llmd visits (he is not on their 'list' for doctors to see) and igenex testing
Oh, my old insurance (blue cross) only allowed me 6 pills of Zith (I took 2 a day) for $20. So every 3 days of Zith cost me $20. I found that ridiculous!!!!!!!
[This message has been edited by JillF (edited 01 March 2005).]
arg82
Frequent Contributor (1K+ posts)
Member # 161
posted
Yes for one of my old insurances.
My current insurance was doing well until this past week. I'm now having to fight for non-antibiotic treatment (daily IV hydration to help with neurocardiogenic syncope and energy level). This is partially due to my dr.'s office screwing up, but that's another post.
posted
No problems what-so-ever
Posts: 468 | From USA | Registered: Jul 2003
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MADDOG
Frequent Contributor (1K+ posts)
Member # 18
posted
Insurance allmost cost me my life,their refusing to pay for the lyme specialist ,caused me the loss of my gall bladder.The ins, has never paid for what I need or for the doc. I need. I call them United No Health care. MADDOG
Posts: 4083 | From Ohio | Registered: Oct 2000
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I'm overweight as a result of the hormone problems and was considering Gastric Bypass as a means of dealing with the weight. Insurance agreed to pay for the bypass, but had noted the hormone issues from previous test results. They contacted me and suggested I seek treatment for the hormomes before doing the surgery, knowing full well that the hormones could end up costing them more.
???
I can't say enough good things about my insurance co.
Posts: 67 | From Kansas City, MO | Registered: Sep 2004
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posted
Yes... had trouble getting more than 4 weeks IV. They eventually extended it... by 2 weeks. Posts: 9 | Registered: Mar 2005
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lhm312
Unregistered
posted
Only trouble with insurance was in getting an adequate number of weeks for IV Rocephin. They stopped paying after 4 weeks, fought for more and got an additional 2, that was all.
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kam
Honored Contributor (10K+ posts)
Member # 3410
posted
HMO=====YES
PPO======YES
MediCAL------YES
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
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posted
oh yeah....all my insurance companies have tried to get out of paying for treatments by using the prashing "beyond reasonable and customary" blah blah blah
Posts: 298 | Registered: Nov 2004
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posted
I applaud your work (and anyone else involved) in this worthy cause. I'm sure you are working your butt off to give us a voice.
I realize that the Northeast has been hit particularly hard by these issues, but in your humble opinion, how do we get similar hearings for other regions of the country. For example, although I was infected in the Northeast, but now live elsewhere, how do I (and others in similar position} feel like we can participate and get fair representation in othe states who are so far behind, they don' t even know what Lyme is?
posted
They have denied all my claims and have deniied all referral my peditrician has put in for lyme doctor and labs. I think is only a matter of time that they will deny ABX if they are ordered by our lyme doctor. They are saying he is out of network and someone where I live can treat. They will not tell me who that mysterious person is.
Posts: 488 | From NY | Registered: Oct 2004
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[This message has been edited by James H (edited 04 March 2005).]
Posts: 714 | From San Antonio TX | Registered: Oct 2004
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Mathias
Frequent Contributor (1K+ posts)
Member # 5298
posted
Not yet. They are covering doctor costs at out of network rates. Abx have been covered in full (minus co-pay).
Posts: 1250 | From New Jersey | Registered: Feb 2004
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Nal
Frequent Contributor (1K+ posts)
Member # 6801
posted
Im not sure what they will be willing to cover yet. I have wonderful Tricare. I filed some claims last week. If the person reviewing them is having a good day, they might pay some. If he's having a crappy day, probably none at all! We'll see.
posted
no - i have medicare - almost all tests have been cover3ed as have doc visits - as you know there is no drug coverage, deb
Posts: 122 | From richmond, ca, usa | Registered: Feb 2004
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posted
Initially there was an issue with IV abx till LLMD brought up the positive PCR...no problems since then...
In-network coverage hasn't been a problem, but Out-of-network docs, tests, services, have frequently required me writing letters of appeal (which is a major headache when I am ill) but eventually, things get reimbursed...
Posts: 802 | From Chicago suburbs, Illinois | Registered: Jun 2002
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Cheryl
Frequent Contributor (1K+ posts)
Member # 75
posted
Well, have had many plans. But basically...
YES for IV/IM - Oxford HMO the worst.
NO for orals and most tests.
PS. Perhaps I should add that Oxford did gladly pay for the hospitalizations that I needed as a result of them denying the IV. GRRRRRR.
[This message has been edited by Cheryl (edited 01 March 2005).]
They have paid for 5 months of IV daily Rocephin (so far) and daily nurse visits! For this I am grateful.
MAMSI, who is now part of United ;(, does however give providers a hard time, demanding notes for every visit and they almost cost me my Lyme dr! She was dropping them and I would not financially be able to continue seeing her. Luckily she ended up signing a new contract with them but they are still demanding of providers.
They will only pay for the minimal dose of anti-virals and the dr gives me samples for one pill per day.
They also make the dr write letters (basically an appeal) for 2 scripts each time they get renewed.
They do cover testing through MDL which is wonderful.
------------------ Ramona
Posts: 7 | From Dulles, VA US | Registered: Mar 2005
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posted
Yes, The insurance will not pay for LLMD visits, but have paid for the medication so far.
Posts: 366 | From Louisville KY. | Registered: Nov 2003
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posted
NO -- except for certain drugs, like zithromax and diflucan. Have got IV treatment covered in the past without a problem.
Posts: 187 | From Washington, DC | Registered: Dec 2004
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posted
My insurance reimburses me at out of network rate for LLMDs and sometimes reduces the total rate allowed before applying the percentage formula. So while they say they pay 80% for out of network docs they paid less than half for my visit to a NY specialist.
They have covered all my meds so far, but I'm not on IV at the unbelievable rate of $5 per prescription for brand name.
They cover my labcorp tests 100%, Columbia Spect 100% (in network).
They cover Igenix, MDL and stonybrook pretty sketchily...can't say exact %, still working this out w them.
lymemomtooo
Frequent Contributor (1K+ posts)
Member # 5396
posted
Insurance pays most of the medicine expenses but the Dr's are out of network and my husband is fighting for some of them currently.. We are responsible for 20% currently, for the things they reimburse.
Posts: 2360 | From SE PA | Registered: Mar 2004
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posted
I have had ongoing problems with the insurance company. They initally approved treatment, then tried to back out after they saw the total expense for IV treatment.
I have had positive test results, but they insist on ongoing positive results to pay for any future treatments.
They want me to go to a LLMD in network, but they don't have one! They continue to refer the case to infectious disease Dr's, but they end up sending it back to the LLMD.
posted
Way back when, I did have one treatment that the insurance approved and then elected not to pay. Filed a department of insurance claim (NJ), and they were ordered to pay it in full.
Of course a related question is, how many have trouble getting LLMD to ACCEPT insurance. So many have opted out of Medicare alone (this knowing that many patients are disabled....) That sucks too.
Posts: 689 | From western MA (we say buttER and pizzA) | Registered: Nov 2004
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