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» LymeNet Flash » Questions and Discussion » Medical Questions » INSURANCE HELP

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Author Topic: INSURANCE HELP
CALIFORNIA LYME
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Member # 6494

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I AM IN THE FIGHT OF MY LIFE WITH MY INSURANCE COMPANY.
I NEED TO KNOW IF THEIR ARE PEOPLE WHO HAVE BLUE CROSS INSURANCE AND ARE ON ROCEPHIN?
1. HOW LONG ON ROCEPHIN
2. DID INSURANCE PAY IT
3. DID THEY GIVE YOU A HARD TIME?
PLEASE RESPOND I NEED ALL THE INFO I CAN GET!

Posts: 13 | From NEWBURY PARK, CA ,USA | Registered: Nov 2004  |  IP: Logged | Report this post to a Moderator
lou
Frequent Contributor (5K+ posts)
Member # 81

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Have you gotten the insurance issue of the Lyme Times? Available thru CALDA. They have a website. Blue Cross in CA very bad for payment of IV.
http://www.lymetimes.org/

[This message has been edited by lou (edited 06 May 2005).]


Posts: 8430 | From Not available | Registered: Oct 2000  |  IP: Logged | Report this post to a Moderator
minoucat
Frequent Contributor (1K+ posts)
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Had the same problem, but not with blue cross.

Was on Rocephin for about 6 months.

Insurance didn't pay for ages -- at least a year. We were about to go to court, treating each refusal as a separate event (so they'd have to have a representative at court each time). Then insurance paid the supplier directly; THEN they called the supplier back and said, OOOOps, we didn't mean to pay you, can we have the money back (No).

Fight it all the way.


Posts: 2331 | From WA | Registered: Jan 2004  |  IP: Logged | Report this post to a Moderator
riversinger
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I'm sorry, California Lyme, but BC/BS has the worst reputation as far as IV antibiotics for Lyme in CA. They usually are unwilling to pay beyond thirty days. If you are hoping to get more, you will have to be very well prepared, and have your doctor willing to do so as well.

Lou's recommendation of the Lyme Times is an excellent one. There are forms to help you prepare insurance appeals, with the arguments well outlined. It is possible that Dr. Fallon's new study on retreatment in late stage Lyme may be helpful in your fight, but I don't believe it has been formally published yet.

You might also check through CALDAs intranet site, as they have many papers available that may be helpful for you. www.calda.intranets.com
scroll down and enter on the left side under "guest"

The other option to consider is whether you might qualify, somehow, for patient assistance. Technically it is available to patients that don't have insurance that covers the medication and whose income levels fall within certain parameters. These vary by manufactureor. (Forgive my spelling, it's too late! )

------------------
Sonoma County Lyme Support


Posts: 2142 | From California | Registered: Nov 2003  |  IP: Logged | Report this post to a Moderator
lou
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There is another way to get IV, which I used because I was not up to a fight with insurance co. and did not qualify for the free stuff (the form asks if you have insurance coverage for meds). If you say yes, even though ins. won't pay, you won't qualify.

Am e-mailing my method to you, in the event it might work for you.


Posts: 8430 | From Not available | Registered: Oct 2000  |  IP: Logged | Report this post to a Moderator
bg
Junior Member
Member # 46416

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Welcome CA lyme! Glad you got answers to your problem; Lou is a wonderful man who is so knowledgeable and shares it with all!

I don't know if you are aware of this or not, but next time, please use LOWER case not all caps when typing your text. It's considered shouting, and I'm sure you are desparate.

Also, you can EDIT your replies at any time! You can NOT edit the topic line...it stays as is so that's why it's important to be specific.

Also, please be as specific as possible in your TOPIC line; "have BCBS, how long do they pay for IV?" You will get many more answers since we have to pick & chose since there are between 40-50+ postings here daily.

Best wishes on your journey; I hope Lou or someone comes up with your solution!

Bettyg, Iowa


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Lynn Lymemom
LymeNet Contributor
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BCBS only paid for 30 days of our dtr's Rocephin despite very strong support from LLMD and us.

Interesting when we paid our BCBS payments in they went to Newberry Park, CA - the same place you are from! Mmmmmmmm......


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nannie
LymeNet Contributor
Member # 5250

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What is the reason for the denial beyond thirty days? If you can please post it.

I am having problems with the co. thta merged with your co.

They delay individual policyholders and other underwritten policyholders far more than self insureds who belong to large groups.

Check your state's insurance regulations, there may be something there that you can use to fight the dispute.

Also-this past week I started using a new tactic. The insurance co. was going to deny under covered services, they were going to claim that it was not a covered benefit. Six months earlier, I asked the ins co. for a written copy of their medical policy for my ins. policy. They wrote back and said that it was not available. Well, I've kept the letter for a rainy day, and I told the insurance company that I would forward their written denials and a copy of the letter about their inability to provide me with a copy of the medical policy, along with my comments and state insurance regulation to their analysts and to their major competitor.I specifically mentioned the name of an analyst who recently had commented about the insurance industry and caused the co.'s stock to go down a few points.

For some reason, they seem to have misplaced or decided against mailing that medical denial letter....


Posts: 183 | From US | Registered: Feb 2004  |  IP: Logged | Report this post to a Moderator
nannie
LymeNet Contributor
Member # 5250

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What is the reason for the denial beyond thirty days? If you can please post it.

I am having problems with the co. thta merged with your co.

They delay individual policyholders and other underwritten policyholders far more than self insureds who belong to large groups.

Check your state's insurance regulations, there may be something there that you can use to fight the dispute.

Also-this past week I started using a new tactic. The insurance co. was going to deny under covered services, they were going to claim that it was not a covered benefit. Six months earlier, I asked the ins co. for a written copy of their medical policy for my ins. policy. They wrote back and said that it was not available. Well, I've kept the letter for a rainy day, and I told the insurance company that I would forward their written denials and a copy of the letter about their inability to provide me with a copy of the medical policy, along with my comments and state insurance regulation to their analysts and to their major competitor.I specifically mentioned the name of an analyst who recently had commented about the insurance industry and caused the co.'s stock to go down a few points.

For some reason, they seem to have misplaced or decided against mailing that medical denial letter....


Posts: 183 | From US | Registered: Feb 2004  |  IP: Logged | Report this post to a Moderator
   

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