posted
I've been a lurker on this board for a while & have never posted. I began treatment for Lyme in March 2006 as I had been taking orals but then began having lyme carditis symptoms. My Infectious Disease Dr. ordered IV Rochephin. 3 weeks into treatment, the cardiac symptoms abated, but the arthrits/fatigue persisted. My ID Dr. wanted to continue w/the treatment. My insurance has been faithfull paying the bill & about $80,000 into the tx. I got a letter saying that the treatment was not medically necessary & they are retroactively collecting all payments. I'm the one that will ultimately get stuck w/this bill & it will put us into bankruptcy. I'm losing sleep over this. Any suggestions?
Posts: 6 | From Overland Park Ks | Registered: Jun 2004
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posted
Cave, thanks for your response. First, my ID Dr. is Lyme Literate. The irritating thing about my case is an Internal Medicine Dr. reviewed my records. So, I guess an Internist trumps a ID Dr.? The new guidelines worry me too. No, I did not need preauthorization. At least that is what my Dr.'s office told me, but I'm worried they made a mistake.
Yes, my ID Dr. will probably be willing to fight this for me, but it makes me sick to my stomach that he has to use his time & resources doing this. He is a very busy man and my insurance company reimburses him pennies on the dollar anyway, and now he has to spend time & resources fighting this battle for me.
One thing that I THINK is in my favor (but will still require a fight on my part & I'm not sure I have the energy to fight) is that I'm an RN for the hospital that this ID Dr. is on staff at. THe hospital is self insured and I used their network......their Tier One (preferred provider network). So in essence, if they don't back me on this, my argument will be that I went to their preferred provider, someone they trust to take care of their hospitalized patients, yet they are going to disregard his plan of care for me?
But the whole point and this is what I don't understand, how can we ever protect ourselves if insurance companies RETROACTIVELY deny payment? If I have chest pains, do I hesitate to go to the ER for fear that my insurance might not pay it? They've been paying this since March & suddenly they have the right to say......."sorry, we want our money back?"
Posts: 6 | From Overland Park Ks | Registered: Jun 2004
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sometimesdilly
Frequent Contributor (1K+ posts)
Member # 9982
posted
Hi-
It might be a good idea to contact your state's health care regulators-
I think most states have different laws about what is permissable for insurance companies to do.
In Maryland, anyway, I believe that state law trumps any counter-provision in insurance company policies.
Of course, there aren't a whole lot of laws out there protecting patients' right to care, but still, asking the appropriate people what's legal in your state will save you trying to get accurate info from that insurance co. of yours that is clearly trying to screw you.
If retroactive billing is not flatly illegal in Kansas, I'd speak to your employer's HR dept. and ask them to point out what pages of your insurance policy allow for such retroactive charges, if any.
please let us know when you get some answers- what's happening to you is as outrageous as it must be scary to you...
good luck-
Dilly
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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If retroactive billing is not flatly illegal in Kansas, I'd speak to your employer's HR dept. and ask them to point out what pages of your insurance policy allow for such retroactive charges, if any.
Absolutely! And contact the state's health care insurance board. FIGHT, FIGHT, FIGHT!!
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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