posted
Hey Everyone... I need some help with an insurance appeal. United Healthcare sent me a letter 9 weeks into my IV Rocephin treatment that they wouldn't cover past the first 4 weeks as it was unproven as being necessary.
I terminated treatment immediately as I can't afford IV Rocephin at a whopping 300$+ a day.
He put me on Ketek which caused Meningitis within 3 days and then the following month when my symptoms were up I had meningitis a second time.
I traded Ketek for Vantin and Flagyl and find that I don't have meningitis but I am also NOT well. I have numbness, tingling, muscle wasting, headaaches, muscle pain, terrible knee issues, and can't exercise.
My Dr. wants me back on IV saying that "Some people are only successful on IV". I still have to appeal my first IV treatment before considering a second round.
Is there anyone out there that has appealed and WON? Could you help me by telling me what to include in teh appeal. Are there specific things that are useful in making the point that MANY Lyme patients remain positive, even CDC positive, following a month course of IV treatment?
Anything you can provide, information, advice etc would be helpful.
trails
Frequent Contributor (1K+ posts)
Member # 1620
posted
I dont know specifically about IV treatment. But I know about appealing and winning.
Just keep at it. Keep a meticulous record of all people that you contact. send things via fax and/or return receipt requested mail.
You will most likely be denied at LEAST one more time. DONT GIVE UP!!! It is a long process and they want you to lose hope and energy. In fact they have studied this and KNOW that you will, unless you are a very strong person and I believe you ARE.
I was able to get an out-of-network surgery covered in full 9 months after the surgery. It cost the insurance $15,000 more than they had originally paid. It was NOT through an appeal process as I had lost all appeals. I just kept calling and calling and calling. Every day. twice a day sometimes. I sent them my file, I sent them doc letters, I sent them so much crap they couldnt hold onto everything or read it all. Eventually the deputy director of the insurance company called ME and then the ball started rolling.
You have to try your best to get past the reps on the phone. Keep trying to claw to the top. The people at the bottom dont have the power to get you what you need and they will just try to sweet talk you....get to someone with real power.
Oh---get a copy of lymetimes insurance issue---a special issue of lyme times. This helped me understand how my insurance worked so I knew WHERE to put pressure. Coz the company was BCBS but it was a self funded plan that was goverened by a large state group--it was the state group that finally got me my money back, NOT BCBS. I would have NEVER known to press the state and not BCBS if it werent for that issue.
Once you understand your insurance company- there is so much that you can do. Start talking smart to them and they get SCARED. Also I "won" a smaller battle about ambulance bills when I wrote to the state attorney general and then called the local TV news station. It was after this all happened that the insurance co realised I mean bussiness. As much as you can get the public's attention.
You deserve the best treatment and care available.
I wish I could be more specific. I can only be a cheerleader for you though. Posts: 1950 | From New Mexico | Registered: Sep 2001
| IP: Logged |
timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
Do a search for "Insurance Appeals" here at lymenet, and my post (letter) should come up.
Do NOT give up. If you read a recent post from me in General Support, you'll see that my insurance just paid the remainder of my Columbia bill.
Good luck. Post back if you have questions.
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic