posted
I know with the whole family it is going to be a constant battle with this insurance company. But I feel like I have a winning battle here.
My husband and I and our two boys have lyme. I have appealed the insurance company and have had coverage for over a year. Until now, since our last dr's appointment in May they have denied and stopped coverage.
Dont get me wrong we have had coverage but that is with lots of letters and lots of hours on the phone with insurance company.
We have insurance with United healthcare and our LLMD is out of network. And our benifit plan states they wont cover for an out of network DR. But I appealed and they accepted and started to cover for us to see our LLMD.
Now the two boys are doing great and our LLMD has said they are in remission and they are off treatment at this time. My husband and I are still getting treated.
I feel that when they gave us privilages to see an out of network doctor and made an exeption to cover him as an in network dr that they cant just drop coverage in the middle of treatment.
I am talking with our employer with who we have the insurance from and they seem to be getting no where with the insurance company.
I feel like I shouldnt go down with out a fight. I feel that if each one of us fight maybe things will start to change. It is sad that people with MS get 100% coverage and they dont know what causes it and the treatment is experimental. And people have a serious bacterial infection "Lyme" and we have to fight for EVERYTHING! And we have LLMD knows what causes it and knows what cures it!
Anyway I need some good advice to fight back with the insurance company.
They are denying and saying that they have infectious disease doctors in network that will treat us. I have asked them how many lyme patients have they treated. They wont answer.
They are stating that it was an accident that they ever covered for us to see our LLMD.
I dont see how they can just stop coverage after they already started to cover. We are in the middle of treatment here. Does anyone know if they can do that?
The crazy thing is we had an appt in January and they covered for all of us. SO they have already covered for an appt in year of 2006.
I am worried if they stop covering for our LLMD will they stop covering for the medicine that he prescribes. Right now My husband and I are on bicillin injections and we have had only a $20.00 dollar copay for 10 doses. I couldnt imagine paying full price for that or for all the medicines they prescribe.
I dont know if Sending a letter and stating I feel discreminated against would help. So if anyone has any advice or success stories with appealing insurance companies please let me know!!! I am not going to go down without a fight.
Thanks!!
Posts: 61 | From ILLINOIS | Registered: Nov 2005
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timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
My insurance does cover out of network doctors...however at what they consider to be "usual and customary charges". But, at least it's covered some. So, I've not had to face your particular battle.
You have a good attitude. Don't give up without a fight.
Do a search here on lymenet for "insurance appeals". My thread should come up (under Timaca post name).
Also look in "general support". I got back $2000 last week from my insurance company after sending a letter of complaint to the state insurance commission.
You can always take that approach if your other attempts fail.
Good luck....Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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posted
I'm so sorry for the problem you are having with your insurance company. I think all these insurance rules are really complicated. But to me, it would be so simple... They should have at least one specialist that treats each disease, if they don't, they should pay as in network (at least as out of network). You probably can try to get some advice from an attorney, or try to write to the Better Business Bureau from your area, they can send your complain to the attorney general's office... Hope you get covered... Goog luck!
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