Well not sure why I didn't see this coming- but my fair hearing that I went to regarding my insurance appeals for antibiotic coverage was once again a total biased, embarrassing wreck!
Of course- chronic Lyme disease or these antibotics for its use don't really exist to them- and there are not really LLMD's either- according to these people...
it was horrible-
my heart was pounding out of my chest- I was in tears and making no sense!!! I had tons of literature but it wasn't the research that they wanted--of course--
I wished so badly I had a kick a** lawyer there to shove this up their butts- pardon my language- but this really makes me mad!
ugh! I am trying to not take it personally- and just let it go- but man did that really upset me- to be so misunderstood and lied to my face!!
what INGNORANCE!! but hey- maybe one day this insurance doctor will understood-
I feel like it's my mission to get this guy to get it- or at least admit I do have Lyme and there is such a thing as a LYme Literate Doctor who is well educated and VERY qualified in treating this disease and these antibiotics are helping ME!!!!!!!!!!!!!
tear-
sorry- just venting-
gosh- I really need to not get so worked up over this!! it's really not worth my PRECIOUS ENERGY!!!!!
thanks for listening!!
hugs! Fawne
-------------------- Energy flows where attention goes~ Posts: 302 | From Kauai | Registered: May 2007
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Angelica
Unregistered
posted
I am really sorry that you had to go through this. I am sure it was a miserable experience.
Lets hope these people learn some how some day that there is such a thing as chronic LD and that there are such things as LLMDs.
Eventually this disease will come out of the dark ages and into the light.
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sparkle7
Frequent Contributor (5K+ posts)
Member # 10397
posted
When I applied for temporary disability - I had a phone hearing... imagine...
It's all a joke. Unfortunately, we have to pay the price.
This is why I believe in alternative treatment. It may not be for everyone but it's helped me.
You will get through it!
Posts: 7772 | From Northeast, again... | Registered: Oct 2006
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
I'm so sorry to hear that you had to go through this wretched experience.
Good idea not to take it personally. It wouldn't matter who you were, you would be denied. It's all about the money and they have a very convenient excuse not to pay. The IDSA has done a good job of providing that for them.
Unfortunately you are not alone in being denied. I have been repeatedly denied for lyme treatment by my husband's work insurance HealthNet. Luckily I have secondary that will pay as long as my doctor and I are willing to battle with them. Of course they have a coverage gap of $4,000 after they pay out less than $3,000.
My doctor wants me on IV Rocephin but I highly doubt I will ever get that covered. Right now I'm on generic Rocephin IM injections. They paid that with a battle. Maybe consider that if you can't get IV.
If insurance hadn't covered it, I could get it at Costco for about $200 a month + the cost of lidocaine and the needles, alcohol etc.. Oddly enough, HealthNet will pay for the lidocaine injectible but not the rocephin. I guess that's better than nothing but it makes no sense.
Take care, Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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bettyg
Unregistered
posted
fawne,
double darn it; so much for being FAIR! i'm so sorry for what you are going thru and having built yourself to be APPROVED when you just got another slap the wrist behavior.
my thoughts and prayers go to you as you learn to deal with this disappointment too!
did you ever read TIMACA'S letter to insurance company in my newbie's package where she received over $50,000 plus back from them?
worth a try still; NEVER GIVE UP until you see the whites of their eyes ... you did huh!
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Don't forget.
The Lyme Times Fall Issue has instructions on how to address this situation.
IDSA is no longer ruler of the nation... and you need to let your insurance company know this immediately.
So far everyone I've heard about who is using this information has gotten what they need.
posted
TC does that apply to SSDI claims too or not really? The IDSA has not helped any lymies applying for SSDI. It seems sometimes hit or miss who gets awarded SSDI.
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Anyone who is being denied because of IDSA guidelines... which is what most insurance and other agencies use as a basis for their denials... should check out this information... and follow through.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
My insurance company didn't seem to give a rip that the IDSA has to reconsider their guidelines. That will change of course if the guidelines change but for now, the guidelines are still in effect from what I've been told.
Glad to hear that others have had success.
TC wrote: The Lyme Times Fall Issue has instructions on how to address this situation.
TC: Is it a special issue and if so which one? I know #39 deals with insurance issues but I think that is an older issue isn't it? I think before the IDSA investigation?
To get to lyme times - go here and click on the right hand side text "order lyme times" http://www.lymedisease.org/
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
Terry, it's the most recent Lyme Times. Mine arrived in the mail just a few days ago. It's a regular edition, not a special one. Hope this helps.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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I received my issue of Lyme Times on my way BACK from the hearing!!! It is FULL of wonderful IDSA articles and how to fight back!! I wanted to turn around and go back - but it was over....
Terry( it is a grey cover- with a silhouette of a large tree and people riding bikes ect. )
I didn't have an attorney- sure wished I did though! I was way over my head...
I have read Timicas' letter....amazing what she accomplished!!! will try and re-read to see if it could help me...
Keebler- I wasn't aware there was a law protecting LLMD's in california? can you lead me to a link, please?
my most recent thought is to send a copy of 'under our skin' to this insurance doctor- and the judge!!!
I have not seen it yet- just ordering it now....
Alternative treatments I am completely open to... and would prefer- but really wanted to give these anti's a chance as long as my body can handle them...
Thanks again- you all are great!!! smiles!!
hugs! and love! Fawne
-------------------- Energy flows where attention goes~ Posts: 302 | From Kauai | Registered: May 2007
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INSURANCE HELP FOR APPEALS from SARAH aka californialyme 11-07 Another good site for insurance help is HARP.org run by an oncologist who got a JD (became a lawyer) because he was tired of his patients being shafted in their treatment because of insurance companies, specifically HMOs for him. He knows ALL about Lyme- his name is Harvey Frey and he is actually a family friend (if you write him from his site tell him Karen Leonards daughter Sarah told you to write hiM!)(that's me*)!
He helped the Lyme patients going after Kaiser as much as able- he won't be your lawyer but we can help you figure out what to do sometimes!!!
from ANN-OHIO There is tons of good info at the site mentioned below,. this is the home page http://www.patientrights.com/index.html It was put together by a Michigan law firm and is one of the best I have ever seen
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Terry K...
Lymedin VA is correct. Thanks Lymed. The information is in this current issue... Fall 2008.. which I haven't actually seen yet but have been told.
A couple of us worked on this project over the summer and I've been sending the information to members behind the scenes who were having problems.. but couldn't publicly share it before it was officially published.
It has helped a number of folks with their problems and there are more plans in the works to do "projects" like this... and/or to extend the reach of this one.
This "project" came about because of a denial we had here locally that the patient and I fought for a good while.. and were successful with.
Hopefully that dear patient's efforts and suffering (oh what a nightmare they put the patient through), combined with writing up the process and having it go through our LL lawyers, advocates and doctors for approval, will help others get results.
Soooooooo.. get a copy of the issue if you don't have it.
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!
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I am trying to not take it personally- and just let it go- but man did that really upset me- to be so misunderstood and lied to my face!! 
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