LymeNet Flash: Interesting personal insurance battle

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»	LymeNet Flash » Questions and Discussion » General Support » Interesting personal insurance battle

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Topic: Interesting personal insurance battle

kitkat32
LymeNet Contributor
Member # 9682

posted

Good evening everyone,

I thought I would share something interesting that happened today.

I had LLMD appt. yesterday. I was put back on Zithromax and Flagyl. Zithro was increased to 500 mg.

When I first did this combo my insurance only agreed to pay for 20 tablets a month. LLMD office really had to push for that and it went to the review board with insurance.

I went to pick up new script at pharmacy yesterday and was told insurance would only pay for 4 pills a month.

I called LLMD office this morning and told them they needed to call my ins. and it would have to go under review again. Pharmacy called me this evening to tell me it was all approved.

I called LLMD office back and this is what they told me they did to get approval.

Instead of giving the insurance co. a diagnosis for lyme and co-infections they took every one of my 30 symptoms and matched it up with a code. The receptionist told me the insurance company quickly agreed to approve a 30 day prescription that is good for the next year.

Can you imagine the look on the review boards faces when they are presented with 30 diagnosis codes????? [bonk]

I am really proud of my LLMDs office for doing this for me. I know it must have taken them awhile to pull all that together.

Just thought I would share something good for a change. It might be an idea for others to use in the future.

kit [Smile]

Posts: 655 | From Pennsylvania | Registered: Jul 2006 | IP: Logged |

Aniek
Frequent Contributor (1K+ posts)
Member # 5374

posted

Kit,

Thanks for sharing. My LLMD always puts multiple diagnosis codes on everything. It makes a big difference with insurance.

--------------------
"When there is pain, there are no words." - Toni Morrison

Posts: 4711 | From Washington, DC | Registered: Mar 2004 | IP: Logged |

LaurenTurner
LymeNet Contributor
Member # 12320

posted

That's wonderful!! [woohoo]

Looks like you have a very caring and nice llmd on your side. [Smile]

That is great.

Posts: 248 | From Tejas | Registered: Jun 2007 | IP: Logged |

perplexed
LymeNet Contributor
Member # 1913

posted

Even in non Lyme medical issues, it is all up to those darn codes and how the MDs code the paperwork to the insurance companies.

So happy it worked out for you.

Hugs, Perplexed [woohoo]

Posts: 324 | From Lexington, KY, USA | Registered: Dec 2001 | IP: Logged |

bettyg
Unregistered

posted

whoopie kit; way to go and especially to your drs. office staff! [Wink]

IP: Logged |

Boomerang
Frequent Contributor (1K+ posts)
Member # 7979

posted

Good for you, kit!! Thanks for the info. Much appreciated.

Hope you are doing better.

Posts: 1366 | From Southeast | Registered: Sep 2005 | IP: Logged |

trails
Frequent Contributor (1K+ posts)
Member # 1620

posted

awesome.

very kind of your LLMD to do this.

hold on to them!

Posts: 1950 | From New Mexico | Registered: Sep 2001 | IP: Logged |

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