Sick as we are, we do NOT need insurance co.s to play games with whether we’re covered & for how much, how long. We are too sick to be able to deal w/ it – physically, mentally, emotionally. But they do it all the time…
ATTENTION LYMIES: I need help. I just got a letter from my insurance company saying that they would not pay for services rendered from Sept 4 – Nov 8. They are just now telling me this Nov 14th. So I will be 10’s of thousands of dollars in dept to the infusion company. What can I do? They seem to have found out about lyme. SN
They had previously approved the doses & nursing visits. SN
DISLIKE!!! 😦 SS
Appeal! GT
They did this to me with Bicillin. First several months, I paid out-of-pocket. Then they paid for a while. Then they retroactively denied and I did have to pay back. I appealed, did the grievance, the whole thing and lost – they kept sending their papers on what their definition of acceptable treatment is, and everything else according to them is experimental. This was the beginning of my major downward spiral into debt so I don’t know what to say. JE
if they approved it at first and the DR ordered it, I would appeal it for sure. Let your Dr know about it too. They shouldn’t be able to denie it because of Lyme, if it was causing other medical problems the DR is treating, that’s what is important. I can’t find a Dr who will do the IV for me. Haven’t run into insurance problems YET about that part, but put up a fight. DB
Somehow they are mentioning a Western Blot & lyme disease. They are saying they will only cover the first 28 days. I don’t even know how they found out about lyme in the first place. So how can I appeal? On what basis? I have forms to appeal but I don’t know what I should put in them. I am negative on the Igenex Western Blot but have only a positive PCR, which they will say is because I USED to have lyme. I’m a little freaked out right now. SN
OMG! This is one reason I don’t want to get an IV. This would so happen to me as my luck is just so bad. UGH! I hope you can get it straightened out! AC
I was CDC-positive on the IgeneX Western Blot and positive for all coinfections and it didn’t matter. I sent them excerpts from Dr. B’s guidelines indicating that Bicillin can be nearly as effective as Rocephin and that didn’t help. I sent all kinds of studies, the studies from Fallon at Columbia about long-term antibotics being needed, nothing helped. They had their sheet of acceptable and non-acceptable. Maybe someone else will post who had success with this, but I didn’t. CALDA does have a past issue of Lyme Times about insurance that I looked at but nothing I did seemed to get me anywhere. JE
Talk to your Dr or billing and see if they can help you with the appeal process, or check some of the Lyme forums and see if anyone else has had to fight this and how they did it. This is so UNFAIR to us ! DB
That’s what I’ve been worrying about with IV too. I hope you can get them to pay. AC
I am upset that my infusion company just never said anything to me. I made it clear to them if my insurance wasn’t going to keep paying, I had a cash company that would be cheaper. I would not have kept the nurse. I now have to pay for 20 nursing visits that they billed at 2 hours each (not EVEN close in time, maybe an hour max). And 118 days of rocephin. My infusions cash price of the rocephin is $95 per dose. That would be $11k!! SN
No advice as in UK we dont get insurance at all….so know all about the debt stuff but wishing you luck Sonya..its cruel how they pull the rug, least we know over here we on our own from the off… YF
If I would have known, I would have stopped using them right away. SN
If they had approved it you probably can fight it, although winning it wont cover further treatments, also talk to the iv company usually medical care has two different prices, one for ins, one for out of pocket, they may drop some of the price. JM
I have been told that you need your doctor to write a letter supporting the treatment, saying you have improved wiht it, and keep appealing, appealing, appealing, no matter what. It might also help to contact your elected representative and see if they can put a call in. Most of all I’ve been told that you want to document that the treatment has improved your condition (even if you have to be dramatic). WW
Plus, if worst comes to worse, I would not agree to pay for anything up front. The infusion company is making a lot of money and has room to negotiate, I’d say by at least 50%. But I would just keep appealing with the insurance. Don’t give up! WW
I am scare to death of the picline anyway, now to know that it may not be covered what are our options, so far my insurance has covered all oral abx makes me stress also and we all know stress is not good for lyme, S we will be praying for you…SM
s who is your insurance company??? SM
They did the same thing to us. they owe us 100,000.00 dollars of un reimbursed claims. Our kids were in treatment pre approved and they decided when it was enough and didn’t tell us until we were done with iv treatment. They are the spawn of Satan. KN
We have appealed 4 times are still appealing. No lawyer wants to take on BC/BS…KN
All the coinfections don’t seem to matter to them. I feel your pain and praying for all those going through this kind of nonsense….KN
I’m so sorry S. I don’t understand. If it was pre-approved and services were rendered, how can they charge you? It’s that the point of getting "pre-approved"? I’m so sorry. When I got my PICC every month I waited for a letter cutting me off. It was inevitable. Never did I imagine they could go back and charge me for services that were pre-approved. AF
No kidding. Well, according to my infusion company it was approved. They told me the most I would ever pay out of pocket was $2000k. I told them that my insurance may choose not to pay & she said not to worry about it. SN
Appeal. Follow the advice like those stated above. If they originally approved, appeal. I was denied previously way back when and I kept appealing; then "approved". Can’t say it will happen w/you but it is worth the effort. LN
The Blue Cross approval letter states that it does not guarantee claims payment, which is total BS to me. Why approve, and then unapprove later after the services have been performed? Depending on their processing time, it can be weeks or months before you know that an individual claim was denied. LS
See, but I am not positive on the Igenex test, so on what grounds can I appeal? I will see if I can get my doc to write a letter. And Linda sent me some info from CALDA. I’m going to call my infusion service because every month, I would ask them if my insurance was still approving. SN
Are u talking about months or weeks on the IVs? If so then it is true that BCBS will only pay the 1st 28 days. You need to appeal and ask for a specific reason, unless this is the IV. That they will not touch. That’s b/c of out great friends the IDSA. Since I am disabled & have Medicare also, that picked up some of it but it was still a LOT of money – over $25K (my mom & those who donated to us…) Now the infusion company, who told me every week how much it’s gonna be & I paid it wants $2900 more b/c there was a "miscalculation." hey…I’m telling them, not my fault. I have nothing…so they can sue me til the cows come home & still get nothing… KEH
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