insurance appeals

[Guest guest]

Did anyone include before/after photos in any appeals to the insurance company?

If yes, do you think they were effective? I'm on my second appeal and am trying

to decide. Any and all help is appreciated!

[Guest guest]

Hi - I have no idea as I have not been on IV yet or my daughters but it makes me

so mad that insurance companies think they are the doctor!!  They know when you

should be all better and not the doctor???????  Makes my blood boil!!!!!!!!!!

Good luck - I hope someone can help you .......... so sorry..........  Diane

________________________________

From: JenK <stupidsoygrrrl@...>

Sent: Sun, November 28, 2010 4:10:12 PM

Subject: [ ] Insurance Appeals

 

Hi all,

I was just wondering if anyone had any links or personal tips for going through

insurance appeals for Lyme treatment. I just got a letter yesterday that IV

antibiotics for Lyme treatment after 4 weeks isn't medically necessary so

they're not covering me. I submitted results from two different blood tests, a

spinal tap, and notes from three different doctors all of which came after two

different 4 week IV rounds so I'm just completely thrown for a loop here. I

don't see how in the face of all this proof they could say I'm better and was

hoping to hear from others with advice, tips on what to do next, or just what to

expect. I'd really appreciate it.

Thanks,

Jen

[Guest guest]

Jen, you're probably best off accepting that what you got is what you're going

to get. Four weeks is what the current guidelines mandate, so it's all most

insurance companies will cover. (I'm surprised that nobody on this list warned

you. Most of us have been through this: you are getting absolutely standard

treatment.) From here on out, you're mostly on your own, unless you can get a

clever LLMD to code your bills creatively.

No, you can't sue them. And I apologize for dragging politics into this, but the

fact that you can't appeal to the courts or anyone else is just another proof

that who you vote for actually matters. There's one party that loves to pass

bills that deprive patients of their rights, and another that passes bills that

do their best to restore them. As Lyme patients, we've got a real interest in

which party gets to be in power.

Sara

On Nov 28, 2010, at 3:00 48PM, Diane Biel wrote:

> Hi - I have no idea as I have not been on IV yet or my daughters but it makes

me

> so mad that insurance companies think they are the doctor!! They know when

you

> should be all better and not the doctor??????? Makes my blood boil!!!!!!!!!!

> Good luck - I hope someone can help you .......... so sorry.......... Diane

>

>

>

>

> ________________________________

> From: JenK <stupidsoygrrrl@...>

>

> Sent: Sun, November 28, 2010 4:10:12 PM

> Subject: [ ] Insurance Appeals

>

>

> Hi all,

>

> I was just wondering if anyone had any links or personal tips for going

through

> insurance appeals for Lyme treatment. I just got a letter yesterday that IV

> antibiotics for Lyme treatment after 4 weeks isn't medically necessary so

> they're not covering me. I submitted results from two different blood tests, a

> spinal tap, and notes from three different doctors all of which came after two

> different 4 week IV rounds so I'm just completely thrown for a loop here. I

> don't see how in the face of all this proof they could say I'm better and was

> hoping to hear from others with advice, tips on what to do next, or just what

to

> expect. I'd really appreciate it.

>

>

> Thanks,

> Jen

>

>

>

>

>

>

>

>

[Guest guest]

Thanks, , for reminding me about the special insurance issue of the Lyme

Times! Duh! That's also at lymedisease.org

Jen, I know how you feel. It really can change the whole picture when you start

trying to figure out how much your treatment is worth to you, personally. Do I

want to, or CAN I, pay for it myself? My insurance paid for some weeks of IV,

but not the homecare nurse. Previously it HAD paid for the nurse when my husband

was on IV. I hate the stress. I hate the red tape and paperwork.

Phyllis

>

> From: Phyllis Mervine <pmerv@...>

> Subject: [ ] Re: Insurance Appeals

>

> Date: Monday, November 29, 2010, 11:24 AM

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>  

>

>

>

>

>

>

>

>

>

> Definitely appeal. There is a form letter at www.lymedisease.org. Adapt

>

> it to your specific situation. I need to revise it with the latest info

>

> on the IDSA guidelines review process - it is a little out of date. You

>

> can just cut the part that is no longer timely. You may not win but you

>

> are costing them money dealing with you, and statistics are generated

>

> that we can use to persuade policymakers that changes are needed.

>

>

>

> For instance, CALDA CEO Lorraine discovered that the independent

>

> review process adopted by the California Department of Managed Health

>

> Care Independent Medical Review shows only 18% of Lyme case reviews

>

> favoring the patients vs. a baseline of 41% favoring patients when all

>

> cases submitted are considered (http://wp.dmhc.ca.gov/imr/ ).

>

>

>

> This is not a flaw in the Independent Medical Review program, which is

>

> widely acknowledged to be highly successful in terms of supporting

>

> patient rights, but it does evidence the type of systemic discriminatory

>

> action that is taken against Lyme patients as a result of review boards

>

> adhering to treatment guidelines promulgated by experts with alliances

>

> with the insurance industry (i.e. IDSA).

>

>

>

> Phyllis Mervine

>

> CALDA

>

> Empowering Patients Through Advocacy, Education & Research

>

> www.lymedisease.org

>

>

>

>

[Guest guest]

Is there anywhere online where I could see this article? It sounds somewhat

helpful. The reason they gave me was that according to their guidelines, any IV

treatment past 4 weeks wasn't shown to help lyme treatment and " In some cases

has actually shown to cause more harm " . 

But I've already done two different rounds of 4 week period IV treatment. If I'm

putting in to go through it again, obviously it didn't work!

From: <scvproperties@...>

Subject: [ ] Re: Insurance Appeals

Date: Wednesday, December 1, 2010, 3:38 PM

 

There's a whole library of letters available in the Lyme Times Insurance

Issue from CALDA. This issue is from 2004, but the letters are still relevant.

One is a letter requesting all documentation from the insurer, including the

qualifications of all who were involved in the decision-making process. This

letter also reminds the insurer that they have only 30 days to respond with

copies of full documentation.

IMO, it would be difficult to properly fight a denial without knowing the exact

reasons for it.

According to the chart in this issue, the request for info is the FIRST STEP to

take, before submitting anything else to the insurance company.

>

> Definitely appeal. There is a form letter at www.lymedisease.org. Adapt

> it to your specific situation. I need to revise it with the latest info

> on the IDSA guidelines review process - it is a little out of date. You

> can just cut the part that is no longer timely. You may not win but you

> are costing them money dealing with you, and statistics are generated

> that we can use to persuade policymakers that changes are needed.

>

> For instance, CALDA CEO Lorraine discovered that the independent

> review process adopted by the California Department of Managed Health

> Care Independent Medical Review shows only 18% of Lyme case reviews

> favoring the patients vs. a baseline of 41% favoring patients when all

> cases submitted are considered (http://wp.dmhc.ca.gov/imr/ ).

>

> This is not a flaw in the Independent Medical Review program, which is

> widely acknowledged to be highly successful in terms of supporting

> patient rights, but it does evidence the type of systemic discriminatory

> action that is taken against Lyme patients as a result of review boards

> adhering to treatment guidelines promulgated by experts with alliances

> with the insurance industry (i.e. IDSA).

>

> Phyllis Mervine

> CALDA

> Empowering Patients Through Advocacy, Education & Research

> www.lymedisease.org

>

>

>

[Guest guest]

I seen this and thought I would forward it since you are the only person

I know on IV for lyme. Please let me know how you are doing.

MyraAnne Healey

dba JP-Online Services

64 Abijah Bridge Road

Weare, NH. 03281-4801

603-529-7441 Office

603-486-7442 Cell

603-529-7739 Fax

Website: _WWW.JPOnlineInNH.com_ (http://www.jponlineinnh.com/)

Email: _JPMyra@..._ (mailto:JPMyra@...)

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In a message dated 12/2/2010 8:57:56 P.M. Eastern Standard Time,

stupidsoygrrrl@... writes:

Is there anywhere online where I could see this article? It sounds somewhat

helpful. The reason they gave me was that according to their guidelines,

any IV treatment past 4 weeks wasn't shown to help lyme treatment and " In

some cases has actually shown to cause more harm " .

But I've already done two different rounds of 4 week period IV treatment.

If I'm putting in to go through it again, obviously it didn't work!

From: <_

(http://finance./group/fieldbids/subs_invite)

_scvproperties@..._ (mailto:scvproperties@...) _>

Subject: [ ] Re: Insurance Appeals

_ (http://finance./group/fieldbids/subs_invite)

_ _ (mailto: ) _

Date: Wednesday, December 1, 2010, 3:38 PM

There's a whole library of letters available in the Lyme Times Insurance

Issue from CALDA. This issue is from 2004, but the letters are still

relevant.

One is a letter requesting all documentation from the insurer, including

the qualifications of all who were involved in the decision-making process.

This letter also reminds the insurer that they have only 30 days to respond

with copies of full documentation.

IMO, it would be difficult to properly fight a denial without knowing the

exact reasons for it.

According to the chart in this issue, the request for info is the FIRST

STEP to take, before submitting anything else to the insurance company.

>

> Definitely appeal. There is a form letter at www.lymedisease.org. Adapt

> it to your specific situation. I need to revise it with the latest info

> on the IDSA guidelines review process - it is a little out of date. You

> can just cut the part that is no longer timely. You may not win but you

> are costing them money dealing with you, and statistics are generated

> that we can use to persuade policymakers that changes are needed.

>

> For instance, CALDA CEO Lorraine discovered that the independent

> review process adopted by the California Department of Managed Health

> Care Independent Medical Review shows only 18% of Lyme case reviews

> favoring the patients vs. a baseline of 41% favoring patients when all

> cases submitted are considered (_

(http://finance./group/fieldbids/subs_invite)

_http://wp.dmhc.ca.gov/imr/_

(http://wp.dmhc.ca.gov/imr/) _ ).

>

> This is not a flaw in the Independent Medical Review program, which is

> widely acknowledged to be highly successful in terms of supporting

> patient rights, but it does evidence the type of systemic discriminatory

> action that is taken against Lyme patients as a result of review boards

> adhering to treatment guidelines promulgated by experts with alliances

> with the insurance industry (i.e. IDSA).

>

> Phyllis Mervine

> CALDA

> Empowering Patients Through Advocacy, Education & Research

> www.lymedisease.org

>

>

> [Non-text portions of this message have been removed]

>

[Non-text portions of this message have been removed]

_ (http://finance./group/fieldbids/subs_invite)