posted
I tried to get my child an appointment with three different well known lyme specialists in various parts of the country. All of them have practices devoted solely to Lyme patients and all have addressed the big Lyme annual conferences. None of them accepted insurance. Why is that? You have to pay the initial exam fee upfront and see what your insurance will pay when you submit a claim yourself. You also have to pay the labs upfront and see what your insurance will pay. All together, the first exam is about $3,200 with reimbursement likely amounting to half or less. Why is that? I am not asking why it takes so long to get an appointment, just the no insurance part. And why are they SO EXPENSIVE? Thanks.
-------------------- doodileedoo Posts: 18 | From Chicago suburbs | Registered: Dec 2005
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posted
I have wondered the same thing! It seems we spend so much at the lyme doc, and we are waiting for reiumbursement also! Maybe it is because no one takes the disease seriously in the medical field. This is what I have found out in Michigan
-------------------- Amy Holloway Posts: 255 | From Michigan | Registered: Oct 2005
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robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
This is a very "political" disese. It is very complicated.
this just scratches the surface. Many Lyme docs are persecuted by Mdical boards. Several have up coming hearings. Insurance companies "own" the docs that take insurance.
You will learn as you go on.
Hope this helps, robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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posted
They do not accept insurance because then they are not mandated by guidelines by the insurance companies on how they treat their patients.
Insurance companies have strict guidelines on treatment and abx.
Try getting a referral from your PCP to a LLMD. Won't happen too often because they have to follow the guidelines - refer to a infectious disease doctor or rheumatologist. That's what happened in my case, anyway.
Cinder
Posts: 60 | From USA | Registered: Nov 2005
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posted
No Dr has a problem with accepting insurance, it is the insurance that does not except them. I am on medicaid, the only reason medicaid excepts my dr. is because he is one of the best aids docs in the country, it just so happens that he is also an llmd.
If your going to be upset with anyone, be so with the insurance co's. There greed is really messing up the system.
Posts: 208 | From Greenville SC USA | Registered: May 2005
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Lishs mom
Frequent Contributor (1K+ posts)
Member # 2344
posted
Doodilee,
Our first appt with our pediatric LLMD was a 3 hour appt on a Sunday. The doctors that take insurance are turned in by insurance to their boards, which then persecute the doctors for treating outside the IDSA standard of care,( despite the govt accepted ILADS standard of care for chronic lyme.)
3,200 should include testing for many other things, and those things are usually covered at some percentage by the Insurance. The doctors really do not recieve a whole lot after tests are paid for.
Posts: 1918 | From Central, Oregon | Registered: Apr 2002
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Foggy
Frequent Contributor (1K+ posts)
Member # 1584
posted
An MD told me that she doesn't take ins as it's too much red tape and the payout is too low.
She has enough paying customers to be in a position not to take insurance, Medicare, or medicaid. She tried to help me get reimbursed but no luck, yet.
Posts: 2451 | From Lyme Central | Registered: Aug 2001
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posted
I guess she is just in it for the money! If a doc ever told me that they would never see me again.
Posts: 208 | From Greenville SC USA | Registered: May 2005
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SForsgren
Frequent Contributor (1K+ posts)
Member # 7686
posted
I personally believe that you almost never find a good doctor that take insurance. That has been my experience with over 45 doctors. If they take insurance, they are forced to not doing certain tests, etc. and essentially your healthcare is managed by the insurance company. At some point, good doctors get tired of being told what to do, being on point systems, etc. and decide it is not worth the hassle. If a doctor takes insurance, I tend to see that as a negative moreso than a positive.
-------------------- Be well, Scott Posts: 4617 | From San Jose, CA | Registered: Jul 2005
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Foggy
Frequent Contributor (1K+ posts)
Member # 1584
posted
quote:Originally posted by Bothrops: I guess she is just in it for the money! If a doc ever told me that they would never see me again.
That was my initial reaction but when I heard she has 3 kids in college & drives a piece of crap, I wasn't so "Ticked" off. She does alt treatments unavailable in traditional medicine so that was my logic.
Posts: 2451 | From Lyme Central | Registered: Aug 2001
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robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
I agree with Scott. There are a few good ones ho take insurance, but for the most part insurance dictates. I do not want my treatment dictated by the insurance company.
I do get reimbursed for some of my treatment after I pay out of pocket for it. Seems better this way as insurance can't dictate what the Dr. does.
Just an opinion, robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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posted
Okay, I have a related question. My LLMD doesn't take insurance, and I seek reimbursement (out-of-network and after deductible). But, I was wondering - do you think there is possibly any relationship between the way my LLMD treats me and knowing who my insurance carrier is? In other words, this insurance carrier may have a reputation for harrassing LLMD. Are some worse than others or are they all the same? I only started wondering this, since my LLMD's approach is conservative. I also thought my GP was starting to treat me with some disdain and even mentioned something once about how she wouldn't want to be questioned as to why she was prescribing me such and such. Perhaps it's just the nature of the beast. I'm one of those people who incurred hardly any medical costs . . . until Lyme, of course. So I may be a bit naive.
Thanks!
Posts: 90 | From New Jersey | Registered: Nov 2005
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posted
With the exception of our LLMD, all of the specialists (neurologist, rheumotologist, cardiologist, etc.) accept our daughter's PPO insurance; however, we are only able to get about 15 to 20 minutes of their precious time.
During the specialists appointment, they invaribly limit the discussions to one or two, at the most, symptoms and treatments of same.
During the appointments with Dr. H, our daughter's LLMD, we have spent as long as 2 hours with him. He has never hurried us, never tried to limit the discussions or our questions.
At least for our family, the quality of care our girl is receiving from her LLMD far outweighs the cost savings of dealing with the so-called "specialists" who accept the insurance co-pay.
OBTW: We have been successful in recovering about 20% of the LLMD's standard office visit costs through her insurance company. Although our medical costs have risen significantly, at least she has a real diagnosis and her treatment is going well. Worth every penny.
Posts: 681 | From California | Registered: Oct 2005
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posted
So what do the poor do if they need to see an llmd? I guess that is fair, I mean it is my fault, and every other poor americans fault, that we did not make something of ourselves before we got ill.
How lucky could I get to live 1 hour from the only llmd that accepts medicaid!
Posts: 208 | From Greenville SC USA | Registered: May 2005
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JimBoB
Unregistered
posted
Bothrops: Us poor folks, are just up that creek without a paddle.
We get NOTHING, or else, like in MY case, I treat myself, the best I can. Takes more work studying and I don't have anyone to blame, IF I do it bad, but I was self employed for 40 years, and didn't make enough to be able to afford insurance.
No, my measley SS barely covers NORMAL expenses, let alone any meds.
I sold an old car I had here at a loss, just to be able to get my meds and herbs.
johnnyb
Frequent Contributor (1K+ posts)
Member # 7645
posted
Caught between a rock and a hard place.... People say lyme is a high out-of-pocket disease, but what happens when you just don't have the cash? It's just not there....
"Yes, I know I should be taking all these expensive vitamins and supplements, but I don't have enough money to buy them all, so I can either get more into debt or suffer."
Some choice....
- JB
Posts: 1197 | From New Jersey | Registered: Jul 2005
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Areneli
Frequent Contributor (1K+ posts)
Member # 6740
posted
Are your visits with LLMD have to be so long?
Drs cannot charge ins so much for a visit, so that is why the patient have to cover the difference. As I see many of you have visits lasting 3 hours or more.
My dr also want to be paid for his time so I make the visit short: 10-15 min. I come prepared with typed on a piece of paper my major current symptoms, reaction to last treatment, suggestions for future etc. It takes him only 2-3 minutes to get all the info about me and he doesn't have to write it down as he can keep the copy.
Posts: 1538 | From Planet Earth | Registered: Jan 2005
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posted
That's a really good question. I've wondered this myself.
When we were originally diagnosed by our internist (unusual, I know), he referred us to a llmd in PA who didn't take insurance. I found the J Clinic in NC who did take insurance. However, he has now been brought up on charges by the state Medical Board.
There have also been llmds who don't take insurance who have been prosecuted, so I'm really not sure if it makes a big difference as far as that goes. Most of us still submit our out of pocket costs to the insrance company and the prescriptions are covered by our prescription insurance.
I really believe my current llmd does it so their practice can have a better quality of life. They alternate opeing at 11:00 or 12:00 and closing at 3:00 with a few Saturdays, not the long hours most doctors have to put in to make a profit.
To sum it up, I'm starting to believe there is a profit motive involved; maybe they think they are taking enough of a risk treating the lyme population that it justifies the high prices.
Posts: 132 | From Kentucky | Registered: Dec 2004
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robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
If they were in it for the money, I don't think they would be treating lyme. Why risk your career?
Just my personal experience with my LLMD.
robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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posted
I worked in a dental office at one point for a specialist who chose to only participate with a very few insurance companies.
His reasoning was first of all when a doctor signs on with an insurance company they sign papers which forces them to only be permitted what the insurance company decides is a "reasonable and customary" charge for a service.
So for example if the doctor's fee schedule charges $100 but the insurance company defines reasonable and customary as $80 - the percentage payable to the doc will be based on $80 not $100 so that $20 difference the doctor will be forced to write off.
Dealing with insurance companies takes major time and staffing to deal with. Between preauthorizations, confirming benefits, filing, following up when the insurance company takes it good old sweet time paying...it is an administrative nightmare - even with computers it is frustrating and such a waste of resources.
So most doctors will look at the benefits of referrals from being in an insurance plan and the benefits of not having to pay the staff to deal with it. They may way the plans and see if the insurance company's idea of R&C meets that of the doctors.
At least this is what I believe the doc I worked for did. It is a matter of making sure the costs can be covered for participating in the insurance plan and that it is a good business decision.
Lyme doctors don't have to worry about having a large enough patient population or getting referrals that is for sure. They have enough to deal with without having to deal with insurance companys.
Yes, it would be nice if they all accepted insurance but honestly they probably couldn't stay in practice with all the delays in payment from insurance companies and the denials they would probably get from insurance companies for the treatments they give.
That is my opinion...
Posts: 655 | From NC, Exit 88 on the Deer SuperHighway | Registered: Dec 2004
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Because then the patient is treated by the insurance and pharmaceutical companies cookie cutter guidelines created by BUSINESSMEN - or perhaps treated with symptom control at best..you will in short order have a 'syndrome' of unknown origon, and no cure..
-- big business medicine doesn't make money off getting people well.
Plain and simple. This is true not just in Lyme. Under AMA and FDA - insurance provider / pharmaceutical orchestration, the Cancer survival rate is not mush higher than it was in 1950. (interesting dvd - called 'Hoxey - When healing becomes a crime' - about the Hoxey clinics for Cancer comes to mind)
Yes, 3200 must include allot of bloodwork and I'm guessing other tests that insurance probably would cover if you do them through a participating lab or hospital.
Our initial appointment/evals were hours long, then on average the follow ups were anywhere from 1/2 hr to an hour (unless emergencies or complications arose)
Still, try and get a fully attentive and responsive half hour from any participating Doctor.. most cases you are lucky to get 10 minutes.. and in that time I was told definitively my 'Lymes' was gone after three weeks treatment.. with no tests and complete disregard of rapid decline in health...because that's what the 'guidelines' say. Thanks, but no thanks! Low and behold..months later after proper eval I had DNA evidence in my blood of not only Lyme, but three other vector borne infections. Antibiotics arrested reveresed my spiraling neurological condition from progressive, active infectious encephilitus confirmed in brain scanning. Put that in your guidelines and smoke it!
(Many doctors are hazardous to your health)
The impecable care and concern given by ILADS LLMD's is priceless. Mine called me at home when tests came back and any red flags came up on bloodwerk, ect.
Certainly, any MD employing alternative supportive measures also cannot participate in insurance plans with any hope of providing efficatious care without major harrassment.. Docs in the plans are bound and gagged and often cannot offer their patients the help they need.
Yes, out-of-network Docs are also persecuted.. especially if they speak out and publish allot, testify at hearings.. and (heaven forbid!!) treat chronic persistant infection efficatiously. THAT threatens the precious money saving guidelines!! -- keep in mind the astronomical costs providers face once persistant infection is acknowledged and changes to IDSA guidelines are mandated. Keep in mind the astronomical number of severe and untreated misdiagnosed cases.
The Docs mounting medical evidence are a bigger threat in that sence than if they are nickel and diming the providers through a plan.
Mo
Posts: 8337 | From the other shore | Registered: Jul 2002
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I don't know the ramifications of a doctor taking a certain insurance and then doing things "outside the norm" but I think that the LLMDs don't take insurance because they do not have to...the patients will go see them whether the initial consultation is $100 or $500 regardless of whether insurance is accepted.
It's true that some people won't go because of the cost. However, a person's health is everything and most will find a way. The docs know this...because they are smart people...they are great doctors but also smart business people. I respect them tremendously and am thankful I found such a good one.
But, why is it that my initial consultation was more expensive for one hour than any other doctor I have ever seen?
I think it's because we are all willing to pay it because we are fighting for our health.
-David
-------------------- Same nightmare, different day! Posts: 401 | From East Coast | Registered: Nov 2005
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posted
The best docs do accept insurance and medicaid/medicare.
A dr. who refuses to see poor or less fortunate patients is only a Dr. because of the income. That person could care less about the well being of his /her patient.
Posts: 208 | From Greenville SC USA | Registered: May 2005
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posted
I agree with you 100% David but I think the reason they dont accept insurance is because insurance does not accept them. I think most would if they could. I think the reason medicaid and insurance co's accept Dr.J is because he is an ID Dr. who is well known for treating aids patients. If lyme was the only thing he treated I never would have been able to see him.
Posts: 208 | From Greenville SC USA | Registered: May 2005
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Andie333
Frequent Contributor (1K+ posts)
Member # 7370
posted
I disagree with Bothrops about the best doctors taking insurance.
My LLMD is out of network, charged more for the first appointment, but it also lasted almost 2 hours. Subsequent office visits have been significantly less money but the LLMD has also spent less time with me -- more like an hour.
I think the posters who compare this to standard care ducks and the time they spend is right. I've rarely, if ever, had more than 15-minutes with any of my doctors.
As far as pay, I'm currently seeing a specialist (NOT my LLMD) who is out of network. The procedure he performed on me was necessary to my health, and there was no way I could afford it. He and I worked out something -- a combination of bartering and paying over time. Again, that's something that would never happen with an in-network doc.
My insurance is unbelievably expensive (I'm self-employed), and only pays 50% for out of network docs and meds. Still, it's been worth it to me, being able to get this quality of care and finally, finally beginning to see an improvement in my health, after years of trudging from duck to duck and being told I was "fine."
I'm personally glad my llmd isn't bound by any insurance restrictions and is free and able to treat any and all patients in the ways most effective for them.
Andie
Posts: 2549 | From never never land | Registered: May 2005
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did any other Doc spend a full hour with you? (not to mention diagnose and treat you properly)
I know I am not David but my ENT spent more than an hour with me four times. All insurance co's and medicaid accepted him.
Mo, what makes you so sure you have been dx'ed and treated properly, not to mention the people you speak to on lymenet. Are you completly recovered. I believe there is a real good chance I have chronic lyme but I am open to other ideas all someone has to do is prove it to me and I will be satisfied.
Posts: 208 | From Greenville SC USA | Registered: May 2005
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posted
I'm personally glad my llmd isn't bound by any insurance restrictions and is free and able to treat any and all patients in the ways most effective for them.
All patients! So if I went in there and said I have no money at all and I am sick, they would help me out. LOL!
Posts: 208 | From Greenville SC USA | Registered: May 2005
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posted
Wow this posting has sure had a lot of action!
Here's the deal: The medical association, which is who the insurance people listen to don't think that lyme should be treated for more than 6-8 weeks. Yale came out with a study that said if you have to treat a patient for more than 6-8 weeks then they don't have lyme. I don't know how this study was conducted but OBVIOUSLY they are wrong. Columbia came out with a controdicting piece that said NO, you need to treat the lyme paient until there is no more traces of lyme in the blood work.
If you were an insurance company would you want to go with the one that is more expensive or less? Unforchunetly, in the US we are money driven. Until the medical association changes their view on lyme treatment insurance companies will not cover a good portion of our treatment.
This also brings about more problems for LLMD's because even though they are not specifically working through insurance companies they are being scrutinized by the medical *** . for OVER MEDIDCATING patients. Now a lot of LLMD's are being forced to be very careful and do everything by the book (even though lyme is a majority clinically evaluation)so that they can defend their treatment.
The whole thing is completely obserd-and hopefully things will be changing over the next few years as lyme become more researched and well known across the country.
-Lindsay
Posts: 484 | From Burlingame, Ca | Registered: Sep 2005
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robi
Frequent Contributor (1K+ posts)
Member # 5547
posted
"A dr. who refuses to see poor or less fortunate patients is only a Dr. because of the income. That person could care less about the well being of his /her patient."
Wow! That is quite a sweepng statement. My Doc works Saturdays...... I have had 4 hour appointments ...... don't think this is a money thing for my LLMD.
Please don't make such huge generalizations. They are rarely true.
Be Well, robi
-------------------- Now, since I put reality on the back burner, my days are jam-packed and fun-filled. ..........lily tomlin as 'trudy' Posts: 2503 | From here | Registered: Apr 2004
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