My insurance United Health Care (UHC) (California) PPO approved me for 3 months of IV Rocephin through Corum Health Care. I started getting these letters (a total of 10 of them now) stating that although they were approving the treatment they weren't responsible for the payment. I called them and they said my case was "under review" and not to worry about it, I also called Corum who said I had nothing to worry about.
Well, it's going on 4 months and my Dr. Lyme just changed my dosage to 2grams 2x's a day. UHC did not like this at all, and realized that some how I have been in treatment for a lot longer then they feel necessary.
They sent me a letter stating that I owe all monitaries owed for all treatment! They will no longer continue any authorization to continue lyme treatment as they feel it is unsafe. (aparently, they all have doctorates and are educated in lyme diagnoising and treatment).
Essentially, they want me to pay about $10,000 for this treatment. Isn't this illegal!
My mom is freaking out and I am trying to stay calm about it, but I have no idea how they can do this.
As well, since I started treatment in January I have gotten so so so much better! I am working out again, I have energy, I can go out with friends. I'm definately not "cured" I still have fatigue and pain and ringing in ears and lots of other fun stuff, but I am so much better!
I am so afraid that if I go off it, not only will I not get better but could I get worse? I've seen a drastic improvement in my over all health in only 4 months and I am finally getting back my life after 4 years!
This is the first thing that has really worked for me, and now it could all be taken away! I am so scared and unsure.
Please let me know what you think and how you've dealt with issues like this.
Thanks, Lindsay 22 years old California
Posts: 484 | From Burlingame, Ca | Registered: Sep 2005
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Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
Dear Smiles,
Please contact your state insurance commissioner who is in charge of regulating insurance.
I don't believe they can hold you financially responsible for all treatments as they had approved the initial 3 months.
However, did they ever send you a letter? I realize they told you that you were in review,
but did they ever approve the treatment?
I sure hope that you documented every conversation and have every correspondence from them.
Sad, sad, sad......
I know a bill like that would freak me out too.
You may be able to appeal that decision with supportive letters from your LLMD as well.
Shameful when insurance companies can tell us what is good for us and what is harmful.
It's a business all about making money. You must be costing them too much.
Let's see....long term antibiotics or Lyme?
In my book that is one easy decision.
Hope you can get this resolved.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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posted
I don't have the aproval letter, because Corum (despite me asking repeatedly) hasn't sent it to me.
The letter says that they approve the treatment, but this does not mean that they will be held responsible for the treatment.
The letter they send me on Friday states that after reviewing the information my Doctor has send them they don't feel it's peer review is adequit and they do not cover "experimental or unproven" methods of treating lyme. They also do not treat lyme with IV antibiotics for longer than 30 days and I should review my letter of benefits to prevent any further charges.
This is such crap! but they are clever and have everything in writting and now I am screwed.
They were also kind enough to send an application to the insurance coordinator of California.
As well Corum, would like me to pay them 10,000 due NOW.
I am so ****ed off right now!
Posts: 484 | From Burlingame, Ca | Registered: Sep 2005
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"Illnesses, hover constantly above us, their seed blown by the winds, but they do not set in the terrain unless the terrain is ready to receive them."---Claude Bernard. Posts: 131 | From US | Registered: Dec 2006
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posted
Do a search under Timica -- she has posted her letter on LymeNet. One of the best letters I have ever seen -- it worked for her but took months and months I think before the insurance company actually paid.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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timaca
Frequent Contributor (1K+ posts)
Member # 6911
posted
Sorry for your insurance woes. Do a search here at Lymenet in the "general support" forum, using the words "insurance appeals" using Timaca's member number (should be listed by my name somewhere ). My letters should come up.
Good luck. If all else fails, take your complaint to your state insurance department. Do a google search "california department of insurance" and info on how to contact your state dept of insurance should come up.
PS...I tried to PM you back but your mailbox was full.
Timaca
Posts: 2872 | From above 7,000 ft in a pine forest | Registered: Feb 2005
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). My letters should come up. 
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