momlyme
Frequent Contributor (1K+ posts)
Member # 27775
posted
I am having difficult time figuring out how to proceed with insurance appeals for IV treatment, dressing changes, etc. I have regular insurance, prescription insurance and now I have income assessment from public health... I just reached out for help.
I called them this morning. If you have children with lyme... they take every pediatrics case.
If you are an adult with lyme, it is out of their scope... they will take your information... but cannot help at this time.
**If they see a need (lots of requests) for advocacy for something they do not currently help with, they will seek grants for that area.
-------------------- May health be with you!
Toxic mold was suppressing our immune systems, causing extreme pain, brain fog and magnifying symptoms. Four days after moving out, the healing began. Posts: 2007 | From NY/VT Border | Registered: Aug 2010
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Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
I was wondering if anyone else has contacted this organization - and if so, were they helpful?
thanks, racer
-------------------- Me - Igenex: IgM: 41IND, IgG: 39IND, 41+ but Plasmid PCR Positive Kiddo - after 1 year IV - positive Lyme culture (before IV: IgM:31,34,41,83-93 IND; IgG: 41+++, 66+) Posts: 133 | From CT | Registered: Feb 2011
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chiquita incognita
Unregistered
posted
Hi Heather
THAT's HOT!!! Thank you so much for posting this.
I was also thrilled to find a book in the library that has lots of patient advocate information, funding information...for lyme specifically.
Here is a thread I posted about it with quotes and sources from the book, for anybody who is interested.http://flash.lymenet.org/scripts/ultimatebb.cgi?ubb=get_topic;f=3;t=027038;p=0
Take care, CI
PS any insurance co that dares to do the ultimate in order to support its bottom line...I would be inclined to:
A) PUBLICLY accuse them of conspiracy to commit murder, not mere negligence. Negligence is inadvertent, but this is an act of deliberate will. A whole other category.
B) APpeal to the media, ask them to give news coverage.
C) Write a letter to the editor with condemnations as above, send a copy of the printed newsletter clipping to the insurance company and let them know it is in print, with their name on it!! And your own signed to it.
Let them cough up the money as "apology" even if only to save their own hide!
D) Class action lawsuits are published by the media where private suits are not, said a political strategist to me. That makes a lot of sense. ANd they cost less. A pro bono attorney might just love the high profile publicity of such a case.
E) The book above talks about appealing on the State level, see link above, instrutions included. You can also appeal to your State Senator or Representative's office for a case worker to represent you.
Hold these murderers to it! Glare at them, in the sunshine of the open day! Don't take "no" for an answer!
And appeal to other sources for funding....when we run into a brick wall, the best thing to do is to walk around it, not bang our heads against it!
I suggest to participate in the Nullification movement of the Health *Insurance* (not "care") mandate. As the insurance co's are gaining political support, they are bound to become even more rogue than they already are. We can't let that happen. The ball has got to roll the other way.
Let's help!
Thank you all.
Phew, phew....mopping my brow...enough said already? Sorry folks.... have a great day and I am thinking of you all! ;-)
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posted
Just as a followup - I called Patient Advocate Foundation. After being accepted during initial intake for my child, after sending plan documents to the representative - she said that they should not have taken the case in the first place, since it is out of their scope (mostly cancer I think).
Also, she said that my plan language specifically excludes additional treatment (greater than 30 days IV) for lyme (I think)... I can still appeal she said, they they cannot help.
Disappointing...
racer
-------------------- Me - Igenex: IgM: 41IND, IgG: 39IND, 41+ but Plasmid PCR Positive Kiddo - after 1 year IV - positive Lyme culture (before IV: IgM:31,34,41,83-93 IND; IgG: 41+++, 66+) Posts: 133 | From CT | Registered: Feb 2011
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momlyme
Frequent Contributor (1K+ posts)
Member # 27775
posted
racer - was this for yourself or a child?
My original post mentions that they do not take adult lyme cases. They take every child case. They were very helpful and diligent in the case of my son. They made phone calls, 3 way calls with infusion company, insurance company, etc.
If you have children with lyme and you need an advocate. This company is worth a try. They saved me a lot of legwork and pointed me in the right direction!
-------------------- May health be with you!
Toxic mold was suppressing our immune systems, causing extreme pain, brain fog and magnifying symptoms. Four days after moving out, the healing began. Posts: 2007 | From NY/VT Border | Registered: Aug 2010
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posted
More followup. They called back and offered to write a letter to insurance company for us. My question was for a child... I guess they will help but maybe in a different way for Lyme patients?
In any case, I would suggest that people call them to ask for help - maybe they will realize that we really need their support.
racer
-------------------- Me - Igenex: IgM: 41IND, IgG: 39IND, 41+ but Plasmid PCR Positive Kiddo - after 1 year IV - positive Lyme culture (before IV: IgM:31,34,41,83-93 IND; IgG: 41+++, 66+) Posts: 133 | From CT | Registered: Feb 2011
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