Had you thought about copy/pasting your 4 questions to OFF TOPIC to and emphasize it's LYMIES, not sarcoidosis, that you want responses from:
www.marshallprotcol.com

I bet many there would love to contribute to your 4 poll questions to take to your Penn. legislative committee this Thurs!

Its covered all IVs so far (9 months worth)

And if I wanted to stay warm for the winter I could use all of the denial letters. that we all know as EOB's

Though it has only been 8 months, and I'm not on IV.

I have to appeal everything and even then I am lucky if I get them to pay 50%.

There big excuse is everything is out of network, even then they are suspose to pay 65%.

Most of time they pay around 35%, even after appealing.

YES on what the case manager mistakenly let slip referance to:

the [b]"high dollar"[b] drugs. (IV)

It appears we no longer had the illness when the costs were higher.

Hmmm...

Mo

Have insurance with international company out of Germany- no trouble at all so far-

After you get done eating all that ice cream and shaking your tutu during your R & R after your Maryland hearing this Thursday, yes, I/others would be interested in the answers to all your poll questions.

This way we have some evidence for our states too and health depts.

Now, take 12 deep breaths, and you'll fall asleep now.

Don't worry; you're going to do fine and represent ALL of us lymies well Thurs.

I'd like to be a mouse in the corner to hear all the activity of the day's events! ha.

They haven't given me trouble over oral antibiotic treatments, but IV they've rejected claims for despite appeals, test results, evidence, and all the jumping through hoops they asked for (my family was forced to pay out of pocket for IV treatment after an initial claim and a round of appeals just ended up wasting months of time I could have been spending getting better).

Unfortunately, my LLMD refuses to assist with these issues. "we don't take insurance". Does a lab participate with my insurance?"Because we don't take any insurance, it is not our responsibility"
The new trick seems to be for the LLMD to phoneconsult with my other treating physcians. He bills and gets paid, they don't.

MY PCP who does take insurance is getting stuck doing all of the appeal work for a lot of the big name LLMD's. The LLMDs are also passing off all of their liability to PCPs.

When you see an oncologist for cancer treatment, the oncologist does not write a note to the PCP and ask them to prescribe chemo. Why are some LLMD's doing this? When the insurance company denies chemo, the oncologist does not expect the PCP to write the insurance appeal, so why do some of the LLMD's?

LLMD's who leave their patients financially liable for their care and for their treatments and lend little credibility to their cause. I don't like being put in the middle of an LLMD and other MD's, and that seems to be where some of the better known cash practice LLMD's are taking this. No good will come of it.

They agreed to pay and then backed out after 6 weeks of treatment. Then questioned every medication or Dr.s visit from that point on.

Jo

e.g.- insurance requires 3 days in pateint hospitalization prior to home nursing care and home infusion therapy...got that waived.

no problems yet--but we are only taking one abx a month so we can continue to work and so we can stay under the radar of the insurance companies. We just changed insurance but I understand people on BCBS (my insurance before I got layed off last year--is reallly hitting their people hard and fast. If we had more confidence in the insurance we would take more medicine--but we are in diar straits and must keep our jobs or risk losing the house.

Pays to be old and on Medicare.......

(Husband is a 100% disabled veteran, so we have VAChamp, LLMD submitted it, so still waiting to find out).

I don't know if that was any help or not???

Marian

Will post results as soon as I get a chance.

THANKS!

6 pills at time - still fighting appeals for 18 months of IV, once the covered bicillin I had been on it 10 months and finished its course.

We have learned to call any new lab or doctor before tests or appointments and ask for info regarding codes etc. Hubby calls insurance with info and finds out what bottom line cost of test or office visit is beforehand. He sends tons of documentation to his designated claims processor and calls and harasses them if things don't get processed like we think they should be.

Of course the out of pocket costs are prohibitive (mostly paid at 70 % of reasonable and customary). We pretty much gave up on in network doctors although we try to use in network labs and hospitals for tests and procedures.

Most prescription nutritional supplements are not covered and annual prescription cap is $5000 which is not high enough even without IV antibiotics.

quote:

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Originally posted by Kira:
[B]Initially there was an issue with IV abx till LLMD brought up the positive PCR...no problems since then...

B]

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