posted
Hi, I got sick with Lyme while working at a summer camp in '08 and so have a worker's comp case going. I have a hearing coming up and am hoping someone can help with a few things:
1) They are asking me why Lyme doctors do not take insurance. If you can answer this or point me in the direction of an answer that would satisfy the courts, that would be great. 2) They want to know the potential future problems I will have. I got sick 1.5 years ago and am fully functioning now (with only slight daily hand pain), however I am on Mepron, Bactrum and Azithromycin -- so who knows how well I would be doing if off these meds). Again, any "somewhat" official findings about long term problems with Lyme would be greatly appreciated. 3) I am also looking for a NY worker's comp attorney. Since I am back at work I am having a hard time finding one who will take my case. 4) Any info on the need for supplements (they have not been reimbursing me for these and, as you know, they cost a fortune) 5) Any info on the need for acupuncture (they have also not been reimbursing me for this).
Thanks so much!! And wishing everyone good health. Beth [email protected]Posts: 22 | From Los Angeles | Registered: Nov 2008
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pmerv
Frequent Contributor (1K+ posts)
Member # 1504
posted
You might find some info in the special insurance issue of the Lyme Times through the CALDA site lymedisease.org
-------------------- Phyllis Mervine LymeDisease.org Posts: 1808 | From Ukiah, California, USA | Registered: Aug 2001
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luvs2ride
Frequent Contributor (1K+ posts)
Member # 8090
posted
I haven't been told by doctors why they don't take insurance so this is just my thoughts about it.
1-They spend more time with us than the average doctor and more time than insurance allows so they are not compensated adequately.
2-Insurance will not cover the way the doctor wants to treat.
3-It is costly to keep staff for the sole purpose of filing insurance and following up to be sure they receive payment.
-------------------- When the Power of Love overcomes the Love of Power, there will be Peace. Posts: 3038 | From america | Registered: Oct 2005
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posted
Future problems: well my daughter contracted Lyme 2 1/2 to 3 years ago, and was dx'ed 3 months ago. Since Aug of 09 (dx Nov of 09) she has lost peripheral vision in both eyes, she has hearing loss, there are days she is too sick (too much pain and too exhausted) to attend school. In the past 3 years, she has suffered from lower back pain, hip pain, swollen fingers and toes (some toes are deformed now), her handwriting is horrendous on some days because it hurts to write, she has lost some cognitive functioning (chooses the wrong word when talking, or the wrong tense of a word, has trouble spelling on some days), she often has short term memory loss, dizziness, tachychardia (rapid heart beat at rest), I have no doubt to could think of more symptoms that she has, but this is a good start.
Posts: 19 | From Michigan | Registered: Feb 2010
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- You now live in LA and need a NY state atty for a case there? Is the upcoming hearing set in NY state? Commuting for this will surely be a drain.
As you mention, since you are back to work, you cannot find a NY worker's comp attorney to take your case. I assume you've gone through the various state support groups for contacts.
* Supplements
I don't think there is any chance of getting help with supplements - unless that was specifically in your insurance policy BEFORE you got lyme. Most insurance coverages do not include supplements.
A B-12 shot may the exception.
According to FDA, supplements are just condensed food and they (by LAW) are not allowed to make any claims for health effects. We know how vital that are but to argue that also runs the risk of getting them outlawed so they can be altered with some additive or dye just enough to be manufactured only as prescriptions.
However, by law, you can deduct supplements if prescribed by a doctor or ND - IF for specific health conditions. That could be key. ND visits and acupuncture are also tax deductible.
* Acupuncture
As for acupuncture, sometimes insurances cover for PAIN such as headaches and carpal tunnel. You say "fully functioning now (with only slight daily hand pain)" so I don't know if that would suffice. But, it may be what is helping you you function now.
Still, not all insurances cover acupuncture. It would depend upon the plan you have. But, I'm assuming it's in your plan or you'd not be pursuing reimbursement. I assumed they have told you what documentation they need for proof of need.
* Future
I don't think workers' comp will go with what MIGHT happen in the future, especially considering that the IDSA says lyme is no big deal.
* LLMDs and lack of Insurance coverage
As for LLMDs not taking insurance - it's the other way around: Insurance companies do not want the LLMDs' business, as the appointments and assessments take longer and there is much more detail than can be done in a 10 minute appointment.
I don't mean to be a downer but I was raised in a family of attorneys who dealt with insurance companies for accidents of all kinds, though not illness.
From what I know about how insurance companies think, I think it would be wise to drop your request for help with supplements (other than for IV vitamins/minerals if your tests showed you low in those). I just don't think this request stands a chance at all.
Other than that, as you know, it is imperative to have a good LL attorney who has a record of success in workers' comp cases - or you'll be eaten for breakfast.
In a perfect world, holistic medicine would all be covered. In a good world, you would not have to fight this. But we live in ugly times with the IDSA really out to destroy the lives of many who try to heal from lyme/TBD. We do have to fight that but, first we have to survive. You may not have the financial nor the monetary resources for a battle.
The best you may be able to do is get good representation with experience but also, with a heart able to actually talk to the other side (but the folks you are up against sound like they are out for a fight).
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Also.. to have your supplements and acupuncture covered you will most likely need a note from the acupuncture folks... and also a note from your treating doctor saying you need the supplements.
Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- What other cases like this has that insurance/workers' comp group granted? Knowing the history of all lyme cases with them will help you know how to proceed. And that is something an atty could find out in a few minutes. Precedence is huge for insurance ruling but so is the LAW for you to receive what is deserved.
If you can't find an workers' comp atty, what about a legal clinic at a law school in NY state? -
Posts: 48021 | From Tree House | Registered: Jul 2007
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