I haven't been on Lyme.Net for a little while--first because of computer issues and lately because typing and looking at the screen for too long makes me nauseous.
I have thought of all of you who guided me and emotionally supported be through diagnosis and the first part of my treatment (ALV, TF, Smurf, Clarissa, six, MB, and others I'm sure I'm forgetting because my Lyme-brain has gotten worse).
I'm sorry I've been gone so long. I have missed you.
I have a question about the company that is supplying me with my IV meds, but I need to explain the situation first:
The company, which is supplying me with the meds contacted me on 08/01/08 stating that they had not been paid for invoices in June and that I would be responsible for all bills past the second week of June.
I was shocked because as far as I knew I was being covered and I hadn't been given the opportunity to opt out of the meds.
Naturally, I had a melt-down because the first break in treatment I had resulted in me feeling sicker and having more side-effects and "HERXes" after commencing treatment again.
The first month of treatment was wonderful and when I re-started after two weeks off, I felt pretty crappy and now it's been up and down, more down than up, AND I'm losing hair, which hadn't happened since my mid-twenties.
I initially took them at their word, but then decided to look into it. My hubby I called the insurance company today....
I'm one of the very lucky few who currently is being covered for IV meds . They told me they had covered me for everything except three bills in July, which are being processed, so I am okay.
The woman lied to me about what had been paid for. Moreover, her company also wants to sign a letter stating that I would be responsible for all costs after the inital 28 days of treatment, even if I was currently being covered.
She stated that with my Lyme diagnosis, insurance may LATER have an issue...even though they are covering me now. Argh. I hope this is making sense because I can't seem to be coherent.
I was livid. I called her today and after four VMs over several hours, she finally called me back.
I told her that it was illegal for her to withhold my meds, if I was currently being covered for them and still needed them because I wouldn't sign a letter and she stated that she never said they would WITHHOLD the meds, which she definitely alluded to.
She told me she would call me back and she instructed the driver to return with the medication, but she is still insisting I sign this letter and I DO NOT WANT TO DO IT.
My friend who is studying to become a lawyer told me that they have no legal right to ask that of me because I'm currently being covered so there is NO issue. I am sick. I am being covered.
They are covering their @sses before anything even happens because I have Lyme. She went so far as to lie about what had been paid for!
They want us to pay $2750 a month, even though my insurance company is covering my bills, so that they won't have to worry about any future issues or paperwork they might have to file.
How is that my problem? If my insurance is covering me, I have nothing to do with what they might or might not do in the future.
I am so ANGRY and so TIRED and I feel alone right now, so I thought I would deal with the dizziness and bad belly to write.
If any of you have any ideas or opinions. Please weigh in. Thanks.
Allanah
-------------------- Allanah Posts: 36 | From New York, NY | Registered: Apr 2008
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joalo
Frequent Contributor (1K+ posts)
Member # 12752
posted
I found this buried in page two.
Anyone??
-------------------- Sick since January 1985. Misdiagnosed for 20 years. Tested CDC positive October 2005. Treating since April 2006. Posts: 3228 | From Somewhere west of the Mississippi | Registered: Aug 2007
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cactus
Frequent Contributor (1K+ posts)
Member # 7347
posted
So sorry you are going through this right now. Try to breathe, and stay calm - you will get through this.
This is upsetting, and stressful, at a time when you most need support.
Your story sounds familiar. I had IV in 2005, and am actually now going through similar problems with the infusion company.
I like the advice your friend in law school gave you. I'm not an attorney, but my thoughts are along the same lines.
You are being covered. Asking you to pay in full for treatment that is already being paid for by your insurance company sounds a bit like fraud, as they would receive payment twice.
Hopefully someone will have some more concrete advice for you.
On my end, to my knowledge, between 2 insurance companies, all of my claims were settled and paid in full.
I did recently receive a form from the infusion co that sounds similar to the one they want you to sign.
They are asking me to backdate the form to 2005, prior to starting my IV! 3 years ago!
It states that I agree to pay all costs not covered by insurance. But at the time of my treatment, everything was covered, and I have received no notice that anything was denied, in fact, I can see that all claims have been paid.
This letter came out of the blue, and it seems suspicious to me as well.
It sounds like the infusion company is hedging their bets, so that if the insurance co demands the payments back, I will have to pay.
My guess is that your infusion company is doing the same thing.
Right or wrong, I can't say - but my letter and form have been placed in the folder where I keep all documents pertaining to health bills. I did not backdate it and send it in. The whole thing felt fishy.
This probably isn't terribly helpful, but at least you know you are not alone!
Hang in there, and focus on the most important part of all of this - getting well.
-------------------- �Did you ever stop to think, and forget to start again?� - A.A. Milne Posts: 1987 | From No. VA | Registered: May 2005
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
I happened to be next to a man who works for my insurance company at PT yesterday. I told him how I had gotten a bill for thousands of dollars from the anesthesiologist's following my surgery.
They continued to send bills and they stated that I was responsible for them, even if my insurance would cover them. Eventually, after Medicare and my secondary insurance paid, I owed less than $50.
He told me that is just a form the billing company send to all patients. He said they get a larger cut if they are paid sooner.
It sounds to me like the infusion company is using the same tactic with you.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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posted
There have also been cases of ins cos who decided not to pay, even tho they had previously said they would. Then they cite medical necessity and the IDSA guidelines. There have even been ins cos who demanded the patients reimburse them because they decided it was not medically necessary. And they might start paying and then stop, and you don't find this out until a big bill has run up.
What exactly is going on here is not clear. I hope lymednva's explanation turns out to be the right one. Infusion companies surely know about the lyme treatment controversy and may be hedging their bets. Don't see why a letter is needed, though, because anytime an ins co does not pay a claim, the patient has to pay it.
Posts: 8430 | From Not available | Registered: Oct 2000
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quote:Originally posted by lou: There have also been cases of ins cos who decided not to pay, even tho they had previously said they would. Then they cite medical necessity and the IDSA guidelines. There have even been ins cos who demanded the patients reimburse them because they decided it was not medically necessary. And they might start paying and then stop, and you don't find this out until a big bill has run up.
......................Don't see why a letter is needed, though, because anytime an ins co does not pay a claim, the patient has to pay it.
They will try anything to get out of paying.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96239 | From Texas | Registered: Feb 2001
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