posted
Please help! I am spending a fortune because my LLMD is not in the Blue Cross Blue Shield network. Are there any LLMDs in the US that are in network? I am desperate... Willing to travel anywhere.
Posts: 81 | From Birmingham, AL | Registered: Mar 2009
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richedie
Frequent Contributor (1K+ posts)
Member # 14689
posted
You have to understand, a true LLMD can not take insurance because then they have to play by the stupid health insurance company rules.
-------------------- Mepron/Zith/Ceftin Doxy/Biaxin/Flagyl pulse. Artemisinin with Doxy/Biaxin. Period of Levaquin and Ceftin. Then Levaquin, Bactrim and Biaxin. Bactrim/Augmentin/Rifampin. Mepron/Biaxin/Artemisinin/Cat's Claw Rifampin/Bactrim/Alinia Plaquenil/Biaxin Posts: 1949 | From Pennsylvania | Registered: Feb 2008
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posted
I used to have Blue Shield, and my LLMD took it. I only had a copay. I still see him and I like him. Send me a PM and I will advise you.
Posts: 374 | From United States | Registered: Nov 2008
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posted
My wife and I live in upstate NY and have Blue Cross Blue Shield.
We are and have spent a fortune on Lyme disease treatments - most of which do not work.
We have been fighting tick borne diseases for 6 years now.
My wife is alive because I was able to work and afford medical care for her because without the out of pocket care she would have passed away.
The human body cannot tolerate untreated, full blown, tick borne diseases.
We travel to Maryland to see our LLMD because there is no such thing as an "in network LLMD."
This is one of the terrible injustices of tick borne disease - if you can pay out of pocket, you have a chance of partial or full recovery, otherwise, you suffer a painful, miserable, existence, and an early death for sure.
During World War II the Nazi doctors routinely denied medical care to sick and innocent people in order to save money and to allow diseases "to quickly get rid of them."
The medical system is doing the same to Lyme disease patients.
The only way change will come is if the doctor's themselves or their families get the disease.
Godspeed to you and your family.
Posts: 45 | From upstate NY | Registered: Sep 2007
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lymielauren28
Frequent Contributor (1K+ posts)
Member # 13742
posted
I'm sending a pm too! I know exactly what dr. you're seeing now - he was my first doctor. I switched to an LLMD in Louisiana and not only do I LOVE him but he takes BCBS.
Lauren
-------------------- "The only way out is through" Posts: 1434 | From mississippi | Registered: Nov 2007
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Lymielauren28 - Your mailbox is full and I did not receive a PM from you. Would love to here who your doc. in Louisian is. Is it Dr. F?
Also, Keltyl - Did not receive your PM. Can you give more information or resend your PM?
Posts: 81 | From Birmingham, AL | Registered: Mar 2009
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posted
I'm sorry, but taking insurance does not behold a doctor to administer different care. All it does is mean the physician must use the correct CPT codes for billing, and accept what that company pays for a particular procedure.
For instance, a doctor that doesn't participate with an insurance company may charge $160 for a level 2 office visit. You will have to pay $160 out of pocket. In the event they take insurance, the doctor agrees to take whatever the company deems "reasonable and customary" for that same level two office visit, for patients that participate. Assuming you don't have a deductible or anything, you pay nothing at the office.
The doctor submits your bill for $160 to insurance. The insurance company says "We will only pay $90, which is our reasonable and customary fee for level 2 office visit" and so the doctor gets $90. This has nothing to do with the kind of care offered, only if doctors choose to..
1. Accept insurance, knowing that even though they'll get paid less per patient, they'll have more patients drawn from the pool that carry that insurance.
2. Reject insurance, if they're sure they have enough people willing to pay what they ask, out of pocket. This is more lucrative in sub-specialties, where people just don't say "Oh, this general surgeon doesn't take my insurance, so I'll just go to another for my gallbladder removal". If you're the only doc in a given area that does a certain thing, and you have enough patients, you can charge whatever you want because people don't have elsewhere to go.
It has nothing to do with certain treatments. All physicians may approve treatments for their patients that insurance won't cover, but this doesn't reflect badly on the physician or anything. For instance, I know someone who needed to have a metal prosthetic joint after breaking a bone - insurance would only pay for steel, because titanium was still "Experimental" in their books. The person paid the difference for the titanium joint instead out of pocket.
Doctors make the choice to reject insurance for financial reasons alone - its expensive, annoying and time consuming to have someone bill, wait until the insurance company takes 6 weeks to send you your check, and accept their rates. This has nothing to do with quality of care.
The only way it could possibly be an issue is if a doctor is doing something that could be perceived as unethical in their treatment, and the insurance "calls attention" to the submissions. While I'm sure this does happen, I think the best course of action is to stand up and justify what you're doing and your results, not look even more guilty by choosing not to take insurance just to stay "under the radar"
I know some LLMDs that take insurance on the east coast and they treat within ILADS guidelines, so I'd call them real LLMDs. Others choose not to, and to be honest I feel they're putting profit or convenience above patient care. They're holding a very specialized set of skills, using experimental techniques, and asking people to pay out of pocket even for mundane things. Often this means that those that don't pay, don't get better, and I consider that unethical. However, others will feel differently.
[ 06-03-2009, 10:13 PM: Message edited by: Blackstone ]
Posts: 691 | From East coast, USA | Registered: Jun 2006
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feelfit
Frequent Contributor (1K+ posts)
Member # 12770
posted
PM sent....my awesome doc accepts BC/BS as well
Posts: 3975 | From usa | Registered: Aug 2007
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posted
Generally lyme patients have a whole host of problems that take a lot of time, more than the ins co will pay for. Also, the doctor has to spend time justifying and fighting the ins co for treatments. He/she does not get paid for this. Then patients tend to want other paperwork done by the doctor, for disability, etc. No pay for this.
And there have been cases of ins cos dropping doctors because lyme disease is costing them too much. So, if a doc does not take insurance, it may have been decided by the ins co, not the doc.
Posts: 8430 | From Not available | Registered: Oct 2000
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lymielauren28
Frequent Contributor (1K+ posts)
Member # 13742
posted
Okay, cleared my box and sent you the info
Lauren
-------------------- "The only way out is through" Posts: 1434 | From mississippi | Registered: Nov 2007
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