posted
Still, doesn't the insurance cover 80% even for out of network doctors?
Posts: 109 | Registered: Aug 2005
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
BCBS is different from state to state. Are you saying all BCBS companies in the entire country are no longer paying?
Let me tell you this ... those AIDS patients will be outraged by this. Rest assured, they will not prevail. Sure Dr. J will sue as well. For breach of contract. I hear they owe him over a million dollars.
In any event, if he is now out of network, they will still have to pay some of the visit, depending on your deductible and coinsurance. The out of pocket payments will just be higher. So check this out first before making any big changes.
I see no way they can get out of paying things they previously approved. I noticed they haven't processed my J Clinic March visit, but already paid for one I had 2 weeks ago.
I also heard they were awaiting results of the medical board hearing, and had withheld payment.
Our family pays $500 a month for that insurance, and my husband's is free as he is the state employee under the plan. Their actions are criminal. It is all about money. They could care less about our health.
Posts: 2275 | From NC | Registered: Oct 2000
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char
Frequent Contributor (1K+ posts)
Member # 8315
posted
New Durham-
Connie-
My husband found out about this because he happened call them today. I may not have all the details straight.
But the thing I am sure of is that Blue Cross has made Dr. J an out of network practice. I talked to an administrator at Dr. J's and she said this is huge and affecting so many people adversely.
Plans are different, so changes will affect patients differently.
An adminstrator there just told me that they may be forced to make everyone pay up front and then file the insurance. They could even get to where they will have to accept only cash. They could be forced to close practice. Blue Cross owes Dr. J $1,000,000.
I hope that you are not affected adversely with the changes, new, Connie and all my friends here.
posted
I just posted about this in general. I received
a call today from them. I just got a picc line
put in last Wed. and began IV treatment. I was
supposed to go back Wed. to get my second med. I
only had 28 days so we were trying to get all we
could. I was told I now have to pay for
everything since last Wed. and pay for everything
up front from now on. I need to know how to
appeal to BCBS to keep doing treatment. I feel
horrible I just broke down on the phone I will
have to have the line pulled and I have no idea
how I will pay for the treatment so far. I
gave up a great three week job just to do the
treatment so I was already financially
strapped. Anyone know how to beg the insurance
that I pay for each month to at least pay for
what I had already started? I needed to do the 28
days
Sorry but I am so upset there is not anyone else
close for me to see that they will pay for.
Take care mimi
Posts: 343 | From usa | Registered: Dec 2004
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char
Frequent Contributor (1K+ posts)
Member # 8315
posted
Mimi-
IM SORRY! I have been thinking of the effect on IV patients today. Not so bad for us doing better on orals.
Listen, we had to pay out of pocket for IV abx for 2 of us at one time and you can get them from certain homehealth agencies for much less than Dr. J's. Rocephin can be had for under $50 per dose for ex. These companies take credit cards. We did it in VA and NC.
There is hope-hang in there!
I have gone into the specifics of how we got IV meds much cheaper ala carte than the package deal they give. Try a search. I am going out to take kids to dr. If you would like to PM me I will check tonight.
posted
I am sorry to hear the "BAD" news about BCBS.
Each local area BCBS is independent and managed somewhat differently.
But seeing out-of-network usually means the same thing. You will be reimbursed for 80% (or whatever your policy states) of what is considered as standard by the insurance company.
This standard is almost always lower than what your doctors would normally charge you.
Some out-of-network doctors ask you to pay the whole amount upfront and file a claim yourself with your insurance.
Some others, though not many, file a claim for you and bill you later.
We have BCBS, and we live in Northern Virginia. My LLMD is out-of-network, and I have to pay for each visit upfront and file a claim myself. What a pain!
I just received the first check from BCBS for the first 3 visits I had filed for together (it took more than a month since I sent my claim.)
I got a little less than 1/2 of what I had paid, although I did start wondering if they would ever pay me back.
Luckily all other doctors of mine are in-network.
However, when we have five people in the family and everybody (mostly me and my hubby) needs prescriptions and various tests (even surgery) done, it just adds up.
shizuko
Posts: 110 | From Northern Virginia | Registered: Nov 2005
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geniveve
Unregistered
posted
here in texas, bcbs will not pay for out of pocket. i have a federal plan and they only pay about 15-20 percent out of pocket and i have to pay the rest. i don't dare go to out of network, i pay through the yingyang..................
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posted
This has happened to other lyme docs over the past several years. The ins co intends to discourage use of these docs. Make it too expensive.
Posts: 8430 | From Not available | Registered: Oct 2000
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5dana8
Frequent Contributor (1K+ posts)
Member # 7935
posted
mimi
I am so upset to hear this news for you
I have also heard that compounding pharms are cheaper.
sending you a pm .
hang in there my NC friend
-------------------- 5dana8 Posts: 4432 | From some where over the rainbow | Registered: Sep 2005
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
One thing to consider as well - MOST LLMDs do not take insurance at all. Dr. J is one of the few who still does. Perhaps this sort of thing has happened to the other LLMDs and that is why they usually require payment up front.
I wouldn't be surprised if this happened with Dr. J. He is spending huge bucks and time fighting these insurance companies.
I also think patients should think about a class action suit to sue these crooks.
They were hoping Dr. J would go down at the hearing, and that did not happen. Now, they are looking for other ways to keep from paying.
Posts: 2275 | From NC | Registered: Oct 2000
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
Anyone want to investigate the possibility of filing a class action suit against NC BCBS? I hear from a good source that the NC Department of Insurance isn't even acting on the hundreds of complaints they have received from patients about BCBS not paying claims.
For anyone interested in pursuing this, let me know. I would like to first pull together some ideas. The ideal situation would be to get an atty who is willing to take this on a contingency basis, but not sure how something like that could be structured. Money up front might be a problem. Many lymies are broke and so am I. But there is nothing really to WIN, other than the benefits. Would be difficult to figure this all out.
Anyone know an attorney with HIV/AIDS or Lyme who would work on something like this?
Grasping at straws here, but if this can be organized, I think it is worth pursuing.
Posts: 2275 | From NC | Registered: Oct 2000
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northstar
Frequent Contributor (1K+ posts)
Member # 7911
posted
Perhaps the person at the Raleigh paper might be interested?
About the other BCBS complaints: these are not all lyme patients? Then that would make the story line a different scenario, with the focus on the State Insurance Board as sluggish, nonresponsive to many complaints.
This wont cost a lawyer, yet.
N.
p.s and how are they punishing the ignorant ones who could not diagnose? Stupidity pays?
Posts: 1331 | From hither and yonder | Registered: Sep 2005
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posted
What you are looking for is someone prominent who does pro bono work. I believe there is a Harvard website which lists attorneys who do this as part of a project, whose name I don't recall. These include such people as the famous tobacco lawyers, the ones who won against the tobacco companies. But I don't think this should be restricted to NC.
In fact, one of them did a very successful rackeeteering lawsuit against several health insurance companies, which resulted in big fines.
Posts: 8430 | From Not available | Registered: Oct 2000
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
quote:Originally posted by lou: What you are looking for is someone prominent who does pro bono work. I believe there is a Harvard website which lists attorneys who do this as part of a project, whose name I don't recall. These include such people as the famous tobacco lawyers, the ones who won against the tobacco companies. But I don't think this should be restricted to NC.
In fact, one of them did a very successful rackeeteering lawsuit against several health insurance companies, which resulted in big fines.
Lou, I was thinking we will probably have to go out of state to find someone worth a darn. I know BCBS has many connections around the state, and as a result, many would not touch this with a ten-foot pole.
Will do a search to see what I can find.
Posts: 2275 | From NC | Registered: Oct 2000
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posted
I hope everyone can find another LLMD. Things like this can be at times harder than the illness itself.
Our LLMD is out-of-network (not Dr. J). Our insurance says the fair & reasonable charge for his area is $158. Our out-of-network coverage is 70%.
Our LLMD charges $240 per visit - which is worth it to me. We pay up front and then submit the claims. We pay $960 per visit for 4 of us and we are reimbursed $442.
-------------------- Peggy
~ ~ Hope is a powerful medicine. ~ ~ Posts: 2775 | From MN | Registered: Apr 2001
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Why not send to your doctor and insurance companies the following information. Tell them you are following the ILADS guidelines for the diagnosis and treatment of Lyme disease, as they are the ONLY valid ones.
```````````````````````````````````````````````
Dear Insurance Company,
The Infectious Disease Society of America (IDSA) 'Practice guidelines for the treatment of Lyme disease' (2000) have officially been withdrawn.
Practice guidelines for the treatment of Lyme disease. (NGC-1898)
Wormser GP, Nadelman RB, Dattwyler RJ, Dennis DT, Shapiro ED, Steere AC, Rush TJ, Rahn DW, Coyle PK, Persing DH, Fish D, Luft BJ. Practice guidelines for the treatment of Lyme disease. Clin Infect Dis 2000 Jul;31(Suppl 1):1-14. [99 references]
```````````````````````````````````````````````
Lyme disease patients should be afforded nothing less than the highest quality of health care services and should have access to the most up-to-date standards of care available.
The International Lyme and Associated Disease Society (ILADS) "Evidence-based guidelines for the management of Lyme disease" are up-to-date (2004), peer-reviewed, diagnostic and treatment guidelines which have been approved for use by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association, the America's Health Insurance Plans [AHIP], the International Lyme and Associated Diseases Society (ILADS), the Lyme Disease Association (LDA) and many world wide organizations.
The ILADS guidelines, therefore, are be THE standard of care. Promoting or allowing the use of guidelines that have been proven to be unsuccessful for many people over the years, which are admittedly outdated and have officially been withdrawn, for ANY reason, is simply not acceptable.
posted
I am meeting with a "friend of a friend" who is an attorney to talk about my about my case. I will let you all know what she says and I will fill her in on all of this mess. I had BCBS until this month and know what you all are going through. We can file a complaint with the NC Dept of insurance, but i am not sure what that would do.
I think Dr. J is going to have to fight this out with BCBS because he was a contracted provider and they are the ones who broke the contract.
I will keep you posted. I probably won't meet with the attorney for a few weeks because she will be out of town. She is lyme friendly and likes to stick it to the insurance companies.
keep your chins up-
Kristen
Posts: 24 | From Oxford, NC | Registered: Oct 2005
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posted
Hey guys I have been on the phone all day With
the help of several of you I have located a
pharmacy that is willing to help. I will find
out tomorrow if Dr. J's office will allow me to
get my drugs from another pharmacy and them do
the care. I have BCBS of SC I have always been
out of network. But because of BCBS of NC
pulling out they will not file any BCBS insurance
and we will all have to pay up front for
everything. So if I can help fight to get
them back please let me know Take care mimi
Posts: 343 | From usa | Registered: Dec 2004
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
I asked my LLMD about this at my appointment today and he said that because of the status change of Dr. J's license it would be cause for BCBS to make him out of network.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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quote:Originally posted by lymednva: I asked my LLMD about this at my appointment today and he said that because of the status change of Dr. J's license it would be cause for BCBS to make him out of network.
Yeah, it sucks, but from a legal stance, BCBS had every right to pull out of their contract... In their eyes, and in the eyes of the folks with big wallets, desk jobs, and perfect health, Dr. J is the one who pulled out of the contract when he supposedly (and I say supposedly because he's my LLMD, and I have a ton of respect for him and his practice) screwed up.
-------------------- Sometimes when I say �Oh, I�m fine� I want someone to look me in the eyes & say �tell the truth�
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