LymeNet Flash: Getting insurance to pay for LLMD office visits

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»	LymeNet Flash » Questions and Discussion » Medical Questions » Getting insurance to pay for LLMD office visits

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Author

Topic: Getting insurance to pay for LLMD office visits

EmilyT
Member
Member # 11632

posted

Hi All,

This may be covered elsewhere in the forums, but I can't find it...I have HealthNet PPO here in CA and am struggling to get them to pay for my Lyme-related expenses (nothing new, of course).

I'm wondering if anyone has been successful in getting them (or any other major insurer) to cover the full cost of office visits with a LLMD. The person I see is over $300/visit and they only cover $70 of that. My strategy with most things is to just continually appeal until they give in, but it hasn't worked with this particular issue. Any suggestions would be much appreciated by me and my wallet!

Thx [Smile]

Posts: 33 | From CA | Registered: Apr 2007 | IP: Logged |

sutherngrl
Frequent Contributor (1K+ posts)
Member # 16270

posted

When you appeal always do everything in writing and always keep a copy!

Posts: 4035 | From Mississippi | Registered: Jul 2008 | IP: Logged |

Lymetoo
Moderator
Member # 743

posted

I was able to get a major insurer to pay 80% of my office visits. I don't think you'll get any ins to pay 100% .. unless there is a company I don't know about!

Just take your office paperwork and mail it in to your insurance if your LLMD doesn't take insurance.

--------------------
--Lymetutu--
Opinions, not medical advice!

Posts: 96239 | From Texas | Registered: Feb 2001 | IP: Logged |

merrygirl
Frequent Contributor (1K+ posts)
Member # 12041

posted

my ins co pays about half

I agree with lymetoo file claims and I would be glad to get ANYTHING back

Posts: 3905 | From USA | Registered: May 2007 | IP: Logged |

Lymetoo
Moderator
Member # 743

posted

No kidding, merrygirl! [Cool]

--------------------
--Lymetutu--
Opinions, not medical advice!

Posts: 96239 | From Texas | Registered: Feb 2001 | IP: Logged |

Keebler
Honored Contributor (25K+ posts)
Member # 12673

posted

-
For some suggestions with dealing with your insurance company - and since California protects doctors who recognize chronic lyme (as opposed to the state to your north which takes away their license) - CALDA may have some answers for you:

http://www.lymedisease.org/

California Lyme Disease Association (CALDA)
-

Posts: 48021 | From Tree House | Registered: Jul 2007 | IP: Logged |

Andie333
Frequent Contributor (1K+ posts)
Member # 7370

posted

My insurer pays about 60% of the cost of the LLMD and related tests.

Not great, but it's better than nothing. I wish you much success dealing with your carrier!

Andie

Posts: 2549 | From never never land | Registered: May 2005 | IP: Logged |

sk8ter
LymeNet Contributor
Member # 8671

posted

most LLMds are out of network so that is why the ins co only will pay a portion of what they thinkis customary.

Posts: 871 | From orange county, ca. | Registered: Jan 2006 | IP: Logged |

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