posted
I wander if any "veteran Lymies" can help...
Are there any helpful links that give detailed information on dealing with our insurance company?
We want to say and do all the right things...so much at stake!!
We were advised to have our primary doctor (who has agreed to work with our future LLMD) to write a letter to our insurance company stating that we need to go outside of the state of Ohio for proper treatment.
I know it's such a touchy subject so we want to make sure all our bases are covered.
Also, what about "pre-approval?"
Are there any known templates of letters used in the past? If not, once we our further along in this journey we will be posting some of our own.
Thanks in advance.
Posts: 13 | From Ohio | Registered: Dec 2008
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bettyg
Unregistered
posted
steve and amy,
here's a good beginning for you to read and extract as much good info as possible!! all from my newbie package link below.
i suggest going there and read all the FINANCIAL RESOURCES info melanie reber compiled from many members; will cover other areas too!!
also, get out your HEALTH INSURANCO BOOKLET and read it in fine detail! see what all it REQUIRES.
fyi, i called iowa's bcbs when i was going out of state to llmd since iowa didn't have any full-time ones then. they gave me VERBAL APPROVAL, said i'd done everything i was supposed to do.
GET IT ALL IN WRITING ... EVERYTHING! they denied me $5,000 of bills for my llmd appts., body lab testings, meds, etc. fought them 1.5 years plus! STRESSFUL.
read over the DIRE LETTER!! just got that info last night! ****************************
5. FIGHTING HEALTH INSURANCE DENYING REIMBURSEMENTS!
posted
You might also want to see if your insurance company has its lyme treatment guidelines online, so you can see what their approach will be.
And the Lyme Times (can google this) has a special insurance issue you can get for guidance.
Posts: 8430 | From Not available | Registered: Oct 2000
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lymednva
Frequent Contributor (1K+ posts)
Member # 9098
posted
I guess I would want to know a little more about your insurance policy before offering advice. I haven't said a word to my insurance company.
Kind of a don't ask, don't tell policy. So far it has served me well.
Are you in an HMO? Do you need to have referrals to go to "specialists?" At one point I had that type of policy, but my retirement (due to Lyme, not age) made that go away, since the retiree policy is better than the one I had previously.
The more info we have, the better we can help you.
-------------------- Lymednva Posts: 2407 | From over the river and through the woods | Registered: Apr 2006
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sutherngrl
Frequent Contributor (1K+ posts)
Member # 16270
posted
So far my insurance company has not questioned me going out of state for treatment. But I don't see what the big deal would be if your GP writes a letter stating that you need to.
Leave it to your doctor to take care of and don't try to explain it to them yourself. Many people go out of state for treatment of cancer and other illnesses, so this should not be a problem.
Posts: 4035 | From Mississippi | Registered: Jul 2008
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kam
Honored Contributor (10K+ posts)
Member # 3410
posted
Not sure if this relates or not.
It is so overwhelming ot me that I have trouble even knowing what my options are.
I did try to get my LLMD approved as an out of network doctor.
I think a lot depends on how the person filing the paper work does. My primary turns it over to the nurse and things pretty much get stopped in their tracks at that point.
Not sure if it is the nurse not knowing how to get things done or whether or not it is just the insurance company.
But, the first part of the process was denied. I did not have what it took to follow through with a visit to a judge with me representing myself and the insurance company having an attorney representing them.
I wish I had been well enough to do so as I think I would have had a good shot. Still don't have what it takes.
TRied to get ketek approved from the insurance company and that was the same thing. Got a big packet in the mail of the attorney for the insurance companies report on why not to approve it.
Again, did not have want it took to go to court to meet with judge and attorney for insurance.
While reading the paper work myself, I would have agreed with the attorney's report. Well done.
He said She said type of thing. WE need more documenation on our side.
Ok Brain is going.
TRied getting lyrica...told insurance would deny it.
Tried getting provigil...told insurance will deny it
Tried getting water therapy...told insurance denied it but never did receive not from insurance on it...so wondering if that was even submitted.
Tried getting lunesta and another Ambien..told insurance would deny it.
Seeing new doctor this month...but he is in the same office as old doctors so we shall see.
He is in the process of getting on the insurance plan I have with SSI.
When I had HMO and PPO, I had insurance deny many things. This is when I was looking for answers and even after the lyme dx.
Went to state watch dogs for insurance companies to try and get things through that specialist recommended.
More paper work but bottom line is the medical field is not there yet wtih the documentation to help us.
Even when I was told I possible had MS and needed some kind of testing done because of in ability to walk the insurance had the documentation saying it was not needed.
Although the specialist and the MS Association said that the testing was needed to confirm or deny.
Records that the insurance company pulled from I assume now becasue I can't recall with CDC said that they ahd done what was necessary.
On the other hand very thankful for what insurance has provided and for my lyme doc who knows if this will not be approved then lets try this.
Like Pam W says...we need to come up with raising funds for better research and solutions such as MD, Aids, Cancer, etc.
That has been on my mind lately. How does one go about that?
I know we have people here and there doing fund raisers.
WE need one big umbrella.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
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