They have copies of the EM rash and positive PCR's of blood and urine. I guess I imagined pulling that tick off my face!!

The insurance company claims that since I do not have a western blot.....I can not have lyme disease. UGH!

Has anyone else run into this problem? I am up against a wall now. This will be my second appeal, but they will not budge. Therefore, I am left with no treatment and no doctor.

What about some of the postings recently about getting meds when and if you cannot afford to pay for them. I know there were posts about this recently.

There were two I recall. Know what I am talking about or want me to hunt those down for you?

You should try this other route, don't want to see you lose ground on this war that you have already waged. It would be a shame to see that go to waste.

I will see what I can find. Take a deep breath and hang in there!

Anyone else know what I am talking about and could help our friend here?

If you have a condition for which abx is the cure, go with that.

PS...I agree, this really stinks. How about contacting your congressman? Insurance board of your state?

There were some posts on how to get treatment for free for those without medical coverage. I hope this helps.

This is one battle in your war. It does really stink, but concentrate your energy towards finding some treatment through one of these avenues.

Easier said for someone not living it, indeed. Try though, seems like we blink and the keets can get the upper hand. Maybe someone at one of these places can keep you on something until you are much better.

Are your symptoms still really bad? How long have you had it?

I am sorry for the mess you have to endure. Sometimes I think the companies just wait til they think we are good and worn down to take advantage of us. Don't let that happen!

Also, you can file an appeal with your state sometimes, (depending on the state). Calling your congressman can help you find out how to do that.

In the book "Coping with Lyme" by Denise Lang, there are many such suggestions for keeping your insurance co. on board. I highly recommend the book.

Take care and I hope one of these suggestions works for you! Keep us posted!

I do know how you feel though. I have an HMO and they won't cover anything not even prescriptions. I had to remortgage my house to get treatment. It is frustrating!

quote:

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Originally posted by Mathias:
The EM rash should be sufficient. Remind them of the CDC guidelines.

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Can't they get around that by stating that the standard treatment is 4 wks of abx?

and yes, Lyme is a clinical diagnosis!

In one case, the insurance company paid our pharmacist after withholding payment for a year, then called the pharmacist 2 days later and said they'd paid by mistake, and could they have the money back (No.)

Another time, it took over 18 months for the insurance company to pay up, but when we made it clear we were going to court, treating each denial of payment as a separate issue (so they'd have to send a representative to court 8 different times), AND that we had all the documentation, they did pay.

There is a link in Treepatrol's newbies thread to tips for winning with insurance appeals, and good info on Chery's Lymeinfo site. (I'm not at my own computer and I don't have those links bookmarked).

Hubby had so many out of network claims his insurance company gave in and finally assigned him a personal processor -- he is on the 3rd one now as they seem to not last long.

He made a friend in the appeals dept also which has been a big help.

Good luck and don't give up the fight.

So...they got a 3 page letter and a 21 page accompanient including several pages from the CDC website stating that lyme is a clinical diagnosis, etc.

You can use that website, for it talks about the rash, etc....

They won't be able to argue against the CDC. They are just hoping you will give up without a fight...that saves them money.

Go to www.cdc.gov/ncidod/dvbid/lyme/diagnosis.htm

Print it off, underline the points you want to make. Include it in your letter to them. Make a copy of whatever you send to them. Send it by Fed Ex. Tell them that you expect a reply in 30 days. Also mention that you are beginning treatment, for you health is at stake, and you will expect them to reimburse you.

Welcome to this 24/7 educational & support group board!

Here's TREEPATROL's and TINCUP'S combination newbie links.
http://flash.lymenet.org/ubb/Forum1/HTML/029917.html

Print off the links then check them off as you read as you could spend several months reading all of this. Treepatrol constantly adds new links as they become available from the members here.

print & read Dr. Barrascono's info first; you will come back to this often.

Also, see Cheryl's extensive web sites on: LD DIAGNOSIS, SYMPTOMS, & TREATMENT ... wonderful!
http://www.lymeinfo.net/lymediseasetreatment.html

Some guidelines from Betty/others on using this message board:

* Do NOT use all caps when posting; it's hard on our eyes. But I know one of our members has macular degeneration, and all caps is what she can see & read so exceptions like this are acceptable for good reasons.

* We chronic, late-stage lymies can NOT read long paragraphs. So please limit your paragraphs to 6-8 lines max of text and double space between paragraphs.

* You can EDIT your text comments anytime. You can NOT edit your subject line so please make it as specific as possible instead of ``help, question'' etc. in order to have more readers/replies in trying to assist you. There are between 30-40 NEW/replies to post daily so we can't read all the posts on our limited time here...thanks for understanding.

* If you use the ``quote'' icon, please DELETE [B] bold at the beginning & ending of the quote. This makes it easier on our chronic, late-stage lyme eyes.

My insurance is a self-insured plan and therefore, is not governed by any state insurance laws.

My doctor only uses Quest and MDL labs and all western blots were negative.....except for band 41.

I understand that lyme is a clinical diagnosis and that an EM rash is diagnostic in itself, but the insurance company doesn't care. For some reason, they want that positive western blot.

I know it doesn't make sense, but I give up for now. I am going to write a nasty letter to the insurance company with documents and the information you have all suggested.

I am too mentally exhausted to pursue another appeal. They make you feel like a mental case, like you are imagining the tick bite, rash and other symptoms.

My insurance only takes Quest Labs. but.....Some how MDL Labs takes my insurance. I don't know what they do but they do get reimbursed by BCBS Direct HMO.
http://www.mdlab.com/html/home.html

If your insurance co ends up paying for this then they will have to accept the results. I hope they are positive!!!!!

However, since only band 41 shows up, the insurance company considers that a negative result. They will not accept positive PCR's (considered experimental by them) and a bulls-eye rash is not diagnostic....in their opinion.

I know for a fact I have lyme disease. I removed the tick and watched the bullseye expand for several months. I also had a previously treated case in the early 80', so I know what to look for.

I will just have to hope that what ever remains in my system will go dormant for a long while!