posted
I don't need this on top of everything else!
I have Blue Cross and Blue Shield insurance. I just got a bill from the clinical lab. I owe $160.
My husband called the insurance and they won't pay for the CD57 KC lab. They said it's experimental.
He told them about my high positive lyme test. They said that they did cover the CD57 lab.. just not the CD57 NK (I don't know what the difference is!??)
From what I've read NK stands for Natural Killers.
Ughhh! I'm so mad. I don't know what to do..
Posts: 248 | From Tejas | Registered: Jun 2007
| IP: Logged |
I guess you'll have to call your ins co every time something other than routine is done.
Stinks for sure!
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
| IP: Logged |
randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
i have bc/bs federal. i had to pay 400 bucks for the igenex test.
what have others paid for this, i don't know, but i know we all pay something different.
this whole insurance business sucks.
i even told one doctor that i would pay cash for my prescriptions or go the base and get them filled, so she wouldn't have to write a scipt and go through the insurance company. she wouldn't do it. hacked me off.......
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
| IP: Logged |
Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Your insurance should have an appeals process. It will be listed in your SPD, which is the summary of your insurance that you should have received.
However, you will notice in the SPD that they don't cover experimental services and that the insurance company reserves the right to determine what is or is not experimental.
If you want to be certain before you get a treatment, you should be able to send diagnosis codes and procedure codes to them before services to get a determination. Ask for the determination in writing though, not just over the phone. And ask them if it is binding, as it may not be if they change policy on covering a procedure.
Insurance does not mean every medical service you get is covered. Every insurance plan has limitations. Things like experimental services, over the counter medications, and dietary supplements are almost universally excluded from coverage.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
| IP: Logged |
posted
After my insurance company paid for 2.5 years of oral antibiotics with a Lyme diagnosis code, they decided I had fibromyalga when my doctor prescribed IV rocephin. Imagine that! I was cured of Lyme by my insurance company! (sorry, little sarcasim). After appealing and getting an outside board to look at my medical records, the insurance company approved 1 month of rocephin. (my doctor ordered 4 months to start). The insurance quoted CDC guidelines that there is "no scientific evidence that more than 30 days of rocephin is necessary." They totally discounted 26 pages of NIH guidelines, Dr. B's guidelines, the fact that CDC guidelines are not meant to be used as treatment guidelines for insurance companies, and other information I gathered and sent to them. In the end, I had to pay for my IV treatment.
Posts: 111 | From York, PA | Registered: Jul 2007
| IP: Logged |
posted
BC/BS just denied my daughter for a PICC line.
BC/BS says they don't think she has lyme disease.
I emailed Michael Moore last night and hoping he
emails back. I asked Michael to do a movie about
lyme disease and to please blow the cover off
this thing.
Posts: 41 | From Warfordsburg,PA | Registered: May 2007
| IP: Logged |
bettyg
Unregistered
posted
bsigel,
UNDER OUR SKIN Lyme documentary is done, being edited; has ALL sides of lyme disease, talking with our LLMDS, IDSA VS. ILADS, AG CONN. BLUMENTHAL's antitrust suit against IDSA .
no, we've got something almost done in a professional manner that we all are looking forward to that isn't slanted!
IP: Logged |
tailz
Unregistered
posted
After reading this post, I'm tempted to halve all my meds.
Doc writes a script for Larium, even with the psych side effects and my history of anxiety and depression. I reluctantly try it - couldn't handle never sleeping again, even the 4 or 5 hours I am able to get off of Larium is not cutting it.
So he writes one for Malarone instead. He also writes a script for zithromax.
I try to fill the Malarone - it doesn't go through.
I try to fill the zithromax - I'm only given 6 days worth instead of 30.
I call the doc - he says he doesn't like dealing with insurance. I'll have to contact my insurance myself.
I contact insurance - they tell me only the doctor can make such a request.
What do you do?
Is this all LEGAL how they bump us all around like this??? I seriously will not be responsible for what I do when I get tired enough of this infection and one more thing ticks me off while my brain is inflammed.
IP: Logged |
just don
Frequent Contributor (1K+ posts)
Member # 1129
posted
Tailz,,, I would find out the persons NAME at the insurance company that MADE those decisions.
Then ask what there doctors license number is for THAT person.
Then tell them you are going to report them to the state medical board for either percribing treatment without examining you,,,,OR practicing medicine without a license!!
Doctors rx meds or not,,,NOT insurance companies!!
IF you are on a group work policy, talk to who ever is in charge of it at your workplace. IF private,check with your agent,,,there are appeals possible!!
IF the deny coverage for anything,,,arent they required to write to inform you of same?? Should also have appeals or at least questions contact info!!
Time to reporet all this to your state insurance commissioner(called dif names dif places)
Go gettem Tiger!!!remaining--just don--
-------------------- just don Posts: 4548 | From Middle of midwest | Registered: May 2001
| IP: Logged |
bettyg
Unregistered
posted
fyi,
insurance commissions can be found this way; i'm using IOWA as an example, but where the IOWA ABBREVIATION, "IA" IS, SHOW YOUR 2-STATE ABBREVIATION TO LODGE A COMPLAINT THAT WAY.
"Do you have a question about a insurance company not paying on a claim or reinbursing you? If so you will need to fill out a complaint form on
line at www.iid.state.ia.us "
use your ONE & ONLY BCBS APPEAL PROCESS 1ST; because when you contact insurance commission; they use OUR CONTACTING THEM AS THE "FINAL" STEP and you can't go on without a FEDERAL/CIVIL CASE SUIT left!
IP: Logged |
tailz
Unregistered
posted
just don - My problem is my doctor doesn't want to get involved, and insurance is telling me they need some sort of phone call or form filled out, by my doctor, to start the prior authorization process.
I don't really like dealing with insurance either, but it's kind of worthless going to an LLMD every month just to be prescribed a medication that either can't be filled - or doesn't work but is on the 'formulary' - or does work, but I only get a short 6 day course, as in the case of zithromax.
IP: Logged |
Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
As much as I hate the insurance companies, and I have to deal with on my job so I really hate them, I don't believe there is any excuse for a doctor not to deal at all with an insurance company.
It's ok for them to choose not to be a part of the network. But if a patient needs a doctors call to get their drugs covered, someone from the doctors staff should get on the phone.
I'm still crazy from the idea that Betty had a doctor sign away her right to submit to Medicare. (I hope you don't mind me complaining about that Betty).
I'll send in my own insurance claims. But if a doctor has chosen to pratice medicine in the U.S. he/she needs to recognize that as screwed up as our system is, it's our system.
We pay for our insurance, or we work for our insurance, or we have a statutory right to our insurance. As bad as it might be.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
| IP: Logged |
tailz
Unregistered
posted
Aniek - That's EXACTLY how I feel.
Take the malarone. Okay, so the insurance said, "Try this (Larium) first."
Or the zithromax - "You only need 6 days."
Well, I tried the Larium and it made me sicker (and cost the healthcare system more money), and my doc says 6 days isn't going to cut it on the zith.
I don't like dealing with insurance either, but unfortunately, it's all we have.
IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
![[Mad]](mad.gif)
![[cussing]](graemlins/cussing.gif)
![[Wink]](wink.gif)
Printer-friendly view of this topic