LymeNet Flash: MD's willing to fight insurance

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»	LymeNet Flash » Questions and Discussion » General Support » MD's willing to fight insurance

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Topic: MD's willing to fight insurance

CharV
Member
Member # 5849

posted

I'm seeing a reputable LLMD (who I really like), but the doc refuses to get involved with the insurance company who's denying coverage of IV treatment because we have not shown medical need. Is this common or do many other docs fight for the patient by providing medical evidence or making some phone calls. Your experiences are appreciated.

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Posts: 62 | From Northwestern, VA, USA | Registered: Jun 2004 | IP: Logged |

Lymetoo
Moderator
Member # 743

posted

If he's in one of the states that are after LLMD's licenses, then I would understand his reluctance to get involved. My LLMD fights insurance tooth and nail. But I think he's in a different circumstance.

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Lymetutu

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

minoucat
Frequent Contributor (1K+ posts)
Member # 5175

posted

This can be a really tough one for the docs. For one thing, fighting with insurance can be extremely time consuming and a real drain on the doc and the staff, especially if they have a lot of LD patients. And, and Lymetoo says, many docs are very wary of getting caught up in the political/insurance mess.

I had one really good doc who made it clear that he'd supply the basic info but did not have the time or resources to go mano a mano with insurance. And one who loved fighting the insurance guys, but he was very old, very successful, very well respected, and had always been a rebel.

In the past, I've written letters about the facts of my case -- outlining the functional impairments, listing supportive dx and bloodwork, medical history, and symptoms, and citing the medical literature-- and then given it to my doc on disk. Several docs have been willing to complete and sign these letters and print them on their letterhead for me to send to insurance. I gathered all the supporting documentation and medical notes myself and submitted them to insurance.

It worked. I think it worked more because it was clear that I'd fight them all the way to court than because they were impressed by "medical necessity."

Posts: 2331 | From WA | Registered: Jan 2004 | IP: Logged |

CharV
Member
Member # 5849

posted

Minoucat - I just sent you an email on this subject.

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Posts: 62 | From Northwestern, VA, USA | Registered: Jun 2004 | IP: Logged |

lymesux
LymeNet Contributor
Member # 6248

posted

Had one doc who refused to file an appeal for me at all when i was terminated at 6 weeks of abx therapy - she however insisted I continue with therapy (my own expense).

My current llmd seems to fight but I'm not in that position. I went to a Infectious Disease doc who worked with my llmd and somehow he managed almost a year w/no insurance issues.

Posts: 799 | From home | Registered: Sep 2004 | IP: Logged |

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