posted
I know with the whole family it is going to be a constant battle with this insurance company. But I feel like I have a winning battle here.
My husband and I and our two boys have lyme. I have appealed the insurance company and have had coverage for over a year. Until now, since our last dr's appointment in May they have denied and stopped coverage.
Dont get me wrong we have had coverage but that is with lots of letters and lots of hours on the phone with insurance company.
We have insurance with United healthcare and our LLMD is out of network. And our benifit plan states they wont cover for an out of network DR. But I appealed and they accepted and started to cover for us to see our LLMD.
Now the two boys are doing great and our LLMD has said they are in remission and they are off treatment at this time. My husband and I are still getting treated.
I feel that when they gave us privilages to see an out of network doctor and made an exeption to cover him as an in network dr that they cant just drop coverage in the middle of treatment.
I am talking with our employer with who we have the insurance from and they seem to be getting no where with the insurance company.
I feel like I shouldnt go down with out a fight. I feel that if each one of us fight maybe things will start to change. It is sad that people with MS get 100% coverage and they dont know what causes it and the treatment is experimental. And people have a serious bacterial infection "Lyme" and we have to fight for EVERYTHING! And we have LLMD knows what causes it and knows what cures it!
Anyway I need some good advice to fight back with the insurance company.
They are denying and saying that they have infectious disease doctors in network that will treat us. I have asked them how many lyme patients have they treated. They wont answer.
They are stating that it was an accident that they ever covered for us to see our LLMD.
I dont see how they can just stop coverage after they already started to cover. We are in the middle of treatment here. Does anyone know if they can do that?
The crazy thing is we had an appt in January and they covered for all of us. SO they have already covered for an appt in year of 2006.
I am worried if they stop covering for our LLMD will they stop covering for the medicine that he prescribes. Right now My husband and I are on bicillin injections and we have had only a $20.00 dollar copay for 10 doses. I couldnt imagine paying full price for that or for all the medicines they prescribe.
I dont know if Sending a letter and stating I feel discreminated against would help. So if anyone has any advice or success stories with appealing insurance companies please let me know!!! I am not going to go down without a fight.
Thanks!!
Posts: 61 | From ILLINOIS | Registered: Nov 2005
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MagicAcorn
Frequent Contributor (1K+ posts)
Member # 8786
posted
Go to this website find your state and notify them of your dilema.
-------------------- Posts: 1279 | From In hiding | Registered: Feb 2006
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Funny you mentioned United Health Care. I just got back from a big meeting with the ducks.. and there was a United Health Care representative there?? Hmmmmmm??? Our mission was to determine our state's policy on diagnosing and treating Lyme.
WHY are they.. an INSURANCE COMPANY.. involved in MEDICAL decissions about diagnosis and treatment of Lyme? And WHY are they even present at a meeting to form policy on Lyme treatment? THEY wouldn't answer that question when asked.. and continued to say they couldn't change things and didn't make policy.
But they were invited by the BIG ducks and the health dept to be at the meetings and they have input! And today they were placed specifically on the COMMITTEE designated to form the policy decissions on diagnosing and treating. They were added to that group.. a YEAR after the fact.. yet claimed they didn't "make policy"... and OUR side was not offered to have anyone added to that committee.
Anyhow..
You said..
"They are denying and saying that they have infectious disease doctors in network that will treat us. I have asked them how many lyme patients have they treated. They wont answer."
Point out the following.. in writing ASAP.
1. The IDSA guidelines.. made by infectious disease ducks.. have OFFICALLY been withdrawn by the AMA and other organizations from the National Clearing House. They are OUTDATED and not suppose to be used.
Those are the guidelines your insurance company is following.. and has been following. Notify United Health Care IMMEDIATELY in writing... because the IDSA guidelines are supposed to be updated any time now... but notify them NOW that you are following the ILADS guidelines.. as they are the ONLY vaild, peer-reviewed ones authorized to be in use.
Do it NOW.. don't wait!!!!
2. If your diagnosis is CHRONIC Lyme.. or late stage Lyme... You MUST point out to the insurance company that the guidelines they are using (IDSA) do NOT address CHRONIC Lyme.. or coinfections.. and do not admit they even exist. THEREFORE...
You need a doctor experienced in treating CHRONIC Lyme.. and one using ILADS guidelines. Infectious disease doctors are NOT qualified to treat a disease they won't admit exists in their own guidelines.
3. If you have been treated once.. then put back on antibiotics after being off... especially by ANY idiot doctors.. there is another arguement.
If chronic Lyme doesn't exist.. and all they think is needed is 4 weeks of antibiotics and you are cured... then WHY did they provide a second round.. and/or third round.
They can't have it both ways!
They can't say once treated you don't have living organisms... and then give you medications that address LIVE organisms. THEN... cut you off saying you don't have live organisms.
quote:Originally posted by Tincup: Funny you mentioned United Health Care. I just got back from a big meeting with the ducks.. and there was a United Health Care representative there?? Hmmmmmm??? Our mission was to determine our state's policy on diagnosing and treating Lyme.
WHY are they.. an INSURANCE COMPANY.. involved in MEDICAL decissions about diagnosis and treatment of Lyme? And WHY are they even present at a meeting to form policy on Lyme treatment? THEY wouldn't answer that question when asked.. and continued to say they couldn't change things and didn't make policy.
But they were invited by the BIG ducks and the health dept to be at the meetings and they have input! And today they were placed specifically on the COMMITTEE designated to form the policy decissions on diagnosing and treating. They were added to that group.. a YEAR after the fact.. yet claimed they didn't "make policy"... and OUR side was not offered to have anyone added to that committee.
Anyhow..
You said..
"They are denying and saying that they have infectious disease doctors in network that will treat us. I have asked them how many lyme patients have they treated. They wont answer."
Point out the following.. in writing ASAP.
1. The IDSA guidelines.. made by infectious disease ducks.. have OFFICALLY been withdrawn by the AMA and other organizations from the National Clearing House. They are OUTDATED and not suppose to be used.
Those are the guidelines your insurance company is following.. and has been following. Notify United Health Care IMMEDIATELY in writing... because the IDSA guidelines are supposed to be updated any time now... but notify them NOW that you are following the ILADS guidelines.. as they are the ONLY vaild, peer-reviewed ones authorized to be in use.
Do it NOW.. don't wait!!!!
2. If your diagnosis is CHRONIC Lyme.. or late stage Lyme... You MUST point out to the insurance company that the guidelines they are using (IDSA) do NOT address CHRONIC Lyme.. or coinfections.. and do not admit they even exist. THEREFORE...
You need a doctor experienced in treating CHRONIC Lyme.. and one using ILADS guidelines. Infectious disease doctors are NOT qualified to treat a disease they won't admit exists in their own guidelines.
3. If you have been treated once.. then put back on antibiotics after being off... especially by ANY idiot doctors.. there is another arguement.
If chronic Lyme doesn't exist.. and all they think is needed is 4 weeks of antibiotics and you are cured... then WHY did they provide a second round.. and/or third round.
They can't have it both ways!
They can't say once treated you don't have living organisms... and then give you medications that address LIVE organisms. THEN... cut you off saying you don't have live organisms.
PLUS.. there are NO tests that determine a cure.
Symptoms mean ACTIVE infection.
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Then tell them to go sit in their hat!
Good luck.. and DON'T give up.
Hey, There is no way I will give up. I am confused about some of the stuff you said.
"Doctors have been offically withdrawn by the AMA and other organizations from the national clearing house?!"
Sorry, I just get really confused about all this insurance information. So all I need to do is call the insurance company and or fax them a letter stating just that?!
Thanks for all this information, I will definatly put it to use. I wish I understood AMA, Clearing house, and ILADS and IDSA.. I think you made some sense out of it. Basically guidlines they have to follow. Meaning right now IDSA guidelines made by infectious disease doctors have offically been withdrawn by the AMA.
SO meaning I have more of a reason to be able to see my LLMD. Especially if I bring up the treatment of Chronic lyme!!
THANKS FOR ALL THE INFO!
Posts: 61 | From ILLINOIS | Registered: Nov 2005
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
So far this morning, I've seen 3 posts. One where tutu tells me she has something in a link for me and there is no link. The next where someone seems to want questions rather than answers ?.. and now this? OH NO.. I AM losing it!
Yes.. going back to bed IS still on my list of options concerning things to do today!
Anyhow.. I've re-read my post.. and couldn't find the quote you thought I said and posted above.. which is...
"Doctors have been offically withdrawn by the AMA and other organizations from the national clearing house?!"
The closest I could find to the above was this..
"The IDSA guidelines.. made by infectious disease ducks.. have OFFICALLY been withdrawn by the AMA and other organizations from the National Clearing House."
IF that is the quote you meant... I was trying to say the GUIDELINES have been "withdrawn"... NOT the doctors.
But oh how I do wish we COULD withdraw those doctors too! HA!
Let's see if I can find my other post about it. I thiink it was done before 3 AM.. so maybe it is clearer?
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