I tested positive for both the ELSIA and WB. I don't trust Kaiser to treat me, or treat it correctly, and i cant change insurance till the end of the year.
So what to do? I thought I would just make an appt with a doc who had dealt with Lyme and pay out of my own pocket.
Wrong.
When i made the appt, i told them the story. I had insurance, but would be paying out of pocket.
They didn't say they had any issues with that and gave me an appt.
Now today i go to the appt and they turn me away.
They tell me that since i have insurance with someone else they cant see me, it would be against the law, and that it would be fraud.
I really feel like the world is conspiring against me to never treat this or atleast not until it does irreparable damage.
Although I think it already has.
Im in a state, Colorado, who treat the disease like its a myth. I cant even pay out of my own pocket to see a doctor. Im stuck with Kaiser till the end of the year. And my symptoms are bad. Bad neuro symptoms.
What kind of country do we live in where you cant pay someone cash to look at you because you have 'sold your soul and wallet' to another health provider?
Unbelievable.
Well, i have an appt with Kaiser on Monday. If they decided not to treat me, want more blood work, or anything like that...
I don't know what im going to do.
Wow. This really sucks.
Posts: 47 | From Denver | Registered: Jul 2006
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Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
That sounds really fishy to me.
Why even tell them you have insurance if they don't take it anyways?
I'd call the State Insurance Commissioner and ask if this is legal and allowed practice.
Especially for someone paying out of pocket.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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Geneal
Frequent Contributor (5K+ posts)
Member # 10375
posted
Better yet....come visit me in La. We don't have Kaiser insurance here.
Hugs,
Geneal
Posts: 6250 | From Louisiana | Registered: Oct 2006
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AliG
Frequent Contributor (1K+ posts)
Member # 9734
posted
Perhaps there may be a misunderstanding? I've never heard of such a thing.
Why should someone care WHAT insurance you have if you would be paying cash?
quote: They tell me that since i have insurance with someone else they cant see me, it would be against the law, and that it would be fraud.
Maybe they thought you wanted them to pose as a doctor affiliated with Kaiser to submit a claim to insurance?
Is there any way they could have misunderstood that you intended to pay cash for your visit?
-------------------- Note: I'm NOT a medical professional. The information I share is from my own personal research and experience. Please do not construe anything I share as medical advice, which should only be obtained from a licensed medical practitioner. Posts: 4881 | From Middlesex County, NJ | Registered: Jul 2006
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bettyg
Unregistered
posted
read this link,
here's an opportunity to try after calling your STATE INSURANCE COMMISSIONER'S OFFICE!!
they are taking COMPLAINTS FROM OTHER STATES .... not only california!!!
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
"What kind of country do we live in where you cant pay someone cash to look at you because you have 'sold your soul and wallet' to another health provider?"
Actually it is true. I couldn't believe it either. I set up an appointment for a friend... sent all the medical records.. had everything straight.. and when we got there the same thing happened. And it wasn't Lyme related.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
I find this hard to believe unless you are covered by a government program.
An HMO such as Kaiser cannot make it illegal for you to see a doctor out of their network.
There must be more to the story. Exactly what type of coverage do you have? Can you look at your paperwork to determine out of network charges? There should be information in your paperwork but if not, contact your employer and get the policy on out of network coverage.
For plain old HMO kaiser, you will have to pay out of pocket but you cannot be forced to see only Kaiser doctors unless there have been some changes in the law.
Is your Kaiser insurance part of medicare?
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
TerryK... you said..
"I find this hard to believe unless you are covered by a government program."
Just a thought...
Some folks may not want to disclose all of their personal information.. and it might be best if they don't here on the board.
posted
I agree with terry K -- something just doesn't sound right here.
Regular insurance, PPO's (Preferred Provider) and HMO's all generally have 2 rate schedules -- in network and out of network. If it is out of network the insurance company may or may not require a referral. The amount the insured pays will be different (costs more) for out of network docs.
If you have medicare then you can sign a statement that you are not going to file with medicare and the doc can't refuse to treat you if you are willing to pay.
Maybe you were confused and the doctor's office said you needed to get a referral?
I just don't think it is legal to prevent you from paying to see a doc if you do not plan to file insurance.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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Never got an update, that there was an addition to this thread.
Anyhow, there isn't much more to the story.
I actually was talking to the doc through email. So, when this happened i wrote him and told him and he said...
"I'm terribly sorry. Apparently my clinic manager is even more stupid than I thought. I'll give her a piece of my mind if she ever gets back from lunch.
Of course you can see who ever you want you just can't submit your bill to Kaiser for reimbursement. And even if you did it wouldn't be fraud. So keep your money for an apt with me in August."
Then he called me later on to apologize again and said something about a past event where there was a problem with a Kaiser patient so they just made up some unwritten rule on the fly.
Not 'him', mind you. He wasn't around for that.
And don't quote me on that last part. That conversation was a week ago and pretty fuzzy now.
Posts: 47 | From Denver | Registered: Jul 2006
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