HMOs PacifiCare Kaiser Permanente Blue Shield of California
PPO United Healthcare
Even with a deductible of $1500 I can't imagine that an HMO would be a better option. I am figuring on paying my out of network LLMD and SPECT scan (back East) out of pocket, either way.
I have checked out CALDA's website and no info. My insurance now has been AWESOME at not questioning LD and paying what they are supposed to.
Thanks,
gambler
Posts: 243 | From chicago | Registered: Dec 2005
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posted
We have Blue Shield HMO and it is ok for oral antibiotics, Diflucan, pretty much anything you want, except IV. They denied that within 12 hours of my doctor asking for approval and aren't budging on appeals.
They are not very good at covering lab tests (blood, CT, etc) and we end up paying a lot out of pocket. Much more than when I had United Healthcare PPO. That insurance seemed to cover a lot more without questions... but I wasn't treating Lyme then.
Posts: 236 | From Washington | Registered: Jul 2008
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Jill E.
Frequent Contributor (1K+ posts)
Member # 9121
posted
From what I can tell when I compare notes with my other California Lyme friends, most of us have to pay out of pocket for the majority of physician visits and medications, particularly IM or IV. Even with oral antibiotics, many insurance companies will not authorize the number of days or number of pills of a prescription.
However, a Lyme friend of mine in the same city as me, with the same insurance company, gets almost everything paid for. The difference is that hers is a group plan and mine is an individual plan. So you may do better because your plan will be through an employer
I personally would stay away from the HMOs because I cannot think of a single Lyme doctor who is part of one. However you can use the HMO to do ongoing bloodwork such as liver enzyme tests, etc.
Most of the Kaiser Lyme patients have had terrible trouble and had to go out of network and pay completely out of pocket. Perhaps there is an exception but I think it's rare.
Congratulations on finding a job in California! Many of us who live here are in the economic doldrums!
Good luck! Jill
-------------------- If laughter is the best medicine, why hasn't stand-up comedy cured me? Posts: 1773 | From San Diego | Registered: Apr 2006
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I never forget how lucky we are to have found LLMDs.
But if Lyme hadn't put me on the verge of bankruptcy, I wouldn't have to move to CA to work off my medical bills. And now I can't afford to make the wrong insurance decision, for my health or my finances.
I appreciate the insight,
gambler
Posts: 243 | From chicago | Registered: Dec 2005
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