insurance

[Guest guest]

le

A lot of times insurance companies change their formularies (book that list

acceptable drugs w/o pre approval). All your doc has to do is show that your

respoding to the med and there is no alternative for you at this point in

time and it should not be messed with. This is not an uncommon thing to

happen, so don't panic over it. I would assume it is just a formality and

justification.

Again this is very common..... and if for some reason BC will not approve it

there are other avenues that are fairly unknown to most subscribes that you

can pursue. I do work in the health insurance industry, if there is any

problem please e mail me separately and I will tell you what your next step

is.

It helps to have " connected " friends. <smiles>

[Guest guest]

le

I used to work for PHS in the appeals Dept and if your health care provider

denies you, you can go through the appeal system. Many don't realize that a

denial doesn't have to be taken sitting down. Even though it maybe denied

for experimental reasons and not approved by the FDA, I've seen many denials

turned around in the appeal process. But, you must keep up with it and

follow through.

Good Luck

Call Blue Cross the minute it gets denied if it does. They'll inform you

from there what you need to do.

Take care

[Guest guest]

le----- You need to have your MD's all appeal this one for

you......first off....what is the name of your ins co....email me

privately....I can probably help......I am a Nurse and have been in " Managed

Care " for 10 years.......If U email me please type your subj. in ALL

CAPS.....Thanx....;-) Terri

[Guest guest]

Gillian -

Most people in the U.S. have health insurance through a group plan with their

employers. The employer pays a monthly premium to which the employee may or may

not contribute. Usually the plan is some sort of managed care where there is a

network of doc. that you may see for a small co-pay (usually $5 to $10). To see

a specialist such as a rheumy, you may or may not have to have your primary doc.

issue a referral. Most plans also have an option to use a non-network doctor

who's fees are re-imbursed to you after filing and the insured normal is

re-imbursed about 70-80% of the normal and customary fees from the insurance

company.

Plans run for as long as you continue to make monthly premium payments.

If an employee leaves, he can convert to individual coverage where he pays all

of the monthly premium and again, can continue this plan as long as he pays.

Insurance in the Philadelphia area runs about $200-$400 per month for an

individual and $500-$1000 per month for a family.

Hope this made some sort of sense to you.

Take care,

[Guest guest]

Gillian,

Some people do buy their own health insurance, but it is super expensive. Most of us get our health ins. through our/spouse's employers. The company picks a certain plan or company and we're stuck with it. In our case, our employer chose an HMO...they have their own doctors you get to pick from. We have a primary care doctor that refers us to the various specialist as we need them,but only to HMO specialists. If you want to go to a specialist that is not on their list you have to petition the board of the HMO. And let me tell you these guys LOVE to play God. Their word " is their final answer. "

So m uch comes out of Russ check towards part of the ins. But his company pays most of it. We have a co-pay of $15.00 for each office visit and each prescription is $10.00 co-pay.

If you buy your own health ins. from the company you want, then you can pay by the month, by six months or a year at a time. It is up to you usually. And it is usually renewed yearly...If I'm wrong here everyone, just jump in and straighten me out. And some of these insurances have a deductable say of $300.00 before they will start paying your medical bills. Sometimes that deductable is per person in that family and some policies the deductable for the whole family which would add up much quicker. I'm glad we didn't have a deductable kind when all the kids were still at home, someone was always sick.

Hope that helps and doesn't confuse you. Anybody o ut there an insurance sales person???

Donna

Gillian Rowe <roweg@...> wrote:

Hi AllI wonder if someone could please explain to me the way the Health Insuranceoperates in America?For example, do you take out your own insurance policy? Or are you locked into a health plan via your Company, that you or partner work for?How long does the policy last for? 1,2,3 years?Once the policy expires, do you have to change Doctors, Rheumatologists, forthe next policy?If so, are your medical records transferred to the next Rheumatologist, ordo you start again from scratch?I get the impression that you are ONLY allowed so many visits to theRheumatologist per year, paid for by the Policy. If you then need anemergency appointment, do you pay yourself?I am hoping someone will be able to explain this system to me.Love and God BlessGillianA friend is, as it were, a second self.--------------------------------------------------------------------Help influence the future of medicine and healthcare by participatingin medical research surveys. Our honorariums range from $25 to$200 per survey.1/7302/4/_/494167/_/965837124/--------------------------------------------------------------------|e>-Please visit our new web page at:http://www.wpunj.edu/icip/paWe are currently discussing new chat times. moderates a chat on arthritis atwww.about.com on Thursday evenings, so check thatout in the meantime! E mail at RA@... for details.

[Guest guest]

Insurance is a sore point with me.

The lack of medical insurance for millions of Americans is an embarrassment

to my supposedly enlightened country. I've read estimates that as many as 44

million people, many of whom hold full-time jobs and support families,

cannot obtain coverage.

I'm one of these people.

Last year, my former employer decided they'd simply rather not pay their

Blue Cross bills and defaulted on the payments. Blue Cross canceled our

group policy, but employees weren't told for a couple of months. As a

result, several people under treatment for cancer and other serious

conditions were unable to obtain other coverage because they went beyond the

magical 63-day limit of not having insurance. Beyond this time, a subsequent

insurer, if you're even able to find one, isn't obliged to cover

pre-existing conditions -- and most people in middle age or later have at

least some kind of pre-existing condition.

I had never really trusted my former employer's stability, so had continued

my Blue Cross insurance from my previous job under COBRA provisions. But

when that 18-month limit lapsed, I still found myself unable to secure an

individual policy. Blue Cross and several other insurers turned me down.

Middle age (48, in my case), chronic rosacea, treatment for depression and a

family history of heart disease (despite no problems for me yet) seem to

have been the reasons for being turned down. It all comes down to having

made the transition from probability to statistic, I guess.

I finally was able to buy insurance through my state's high-risk pool.

However, it costs me $6,000 a year. The only positive in all this is that

the plan is administered by Blue Cross and is a PPO.

Then, I was laid off three months ago as part of my region's cesspooling IT

industry. What honks me off is that while employed, my payroll taxes were

still paying for Medicare, Medicaid, and all those vote-getting programs for

the pressure groups du jour. Those illegal Haitian aliens who stormed the

beach in Florida currently have more affordable access to health care than I

do.

It's close to Election Day here in the United States, and when encountering

candidates at the train station doing their grip and grins, I've mentioned

the obscene inequities in America's health care system. I've even pointed

out sections in their own literature these candidates are passing out in

which they trot out the same promises to increase Social Security for

seniors and health care for the poor.

They start nervously looking around for someone else to talk to when I point

out that millions of other people just like me are footing the bill for

those programs -- programs that don't address the needs of millions of

uninsured citizens.

I've told several of these candidates that I'm a reasonable guy and vote for

reasonable candidates -- however, I've explained that if an unreasonable

candidate came along who addressed my health care concerns, I just might

vote for that person.

My T levels are way low, but I've put off starting in on a complex

diagnostic and treatment plan because there are just so many variables at

the moment regarding insurance, what's covered, what isn't, prescription

costs, etc.

No system is perfect. This group regularly hears from members in other

countries whose national health plans might cover emergencies, but fail

miserably to address chronic conditions and non-life-threatening situations.

I don't pretend to know the answer. A basic catastrophic safety net with

options for purchasing additional coverage? Vouchers that would preserve the

insurance industry's participation? Maybe a totally fee-for-service arrange

with health insurance " savings accounts " ? Full-fledged Medicare-style

protection for all? I don't know. But what the United States has now isn't

working for millions of Americans.

Something needs to be done -- and soon.

I'm out of work and my insurance premiums feel like prostatic massage, but

maybe I ought to look on the bright side -- at least I can afford broccoli

and zinc. :-)

Leigh Hanlon

Chicago, USA

[Guest guest]

.. The first thing you need to find out is if BCBS is basing coverage on his medical dx or the schools. In our case, BCBS needed a dx from someone in the medical field before they would cover any services related to AS. Our son is 16 and BCBS covers 80%, so it also depends upon your Ins.,package. I would call the provider directly. I would expect the person working the Q & A desk can answer all those questions specific to your coverage.

If you're wondering about suplemental Insurance through your State, that would qualify you for many services locally, along with respite care, in-home counseling, advocacy etc.. I don't know what State your in, but that is how the program is set up in my State of Minnesota.

When my son is of adult age, he will qualify for a ploethera of State programs and coverage through the Disabilities Act, all that is BASED on his "pre existing" condition. I'm not sure if my information will help, because it differs from State to State

From: <brookestarling@...>Subject: ( ) insurance Date: Friday, December 4, 2009, 12:48 AM

BCBS is offering 100% coverage for Noah up till age 7 for OT, speech, supplements and ABA if we have an autism diagnosis. I thought that this would be an option for us until I read our assessment report again tonight. Here's what it states:"Noah evidenced multiple characteristics commonly associated with Autism such as..... (list of symptoms)""Overall, in comparison to other children with autism of the same age, Noah shows some atypical development and features of autism. However, because placement in the Barron ECS will be his first school placement, an identification of Autism is being deferred. Instead, Noah will qualify for special ed services as a student with a Non-Categorical Early Childhood eligibility with a suspicion of an Autism Spectrum Disorder and a Speech Impairment." My questions are:1) Do we have an autism diagnosis that will qualify us for services w/

insurance, should we choose to go this route?2) Does anyone recommend going the autism route and taking our chances after age 7? (Any ideas about what do to then?) Or is it better to fly under the radar w/ encephalopothy, apraxia, etc? The law states that we would get full coverage until age 7. What would happen after that? Does anyone know if this will affect Noah when he is grown in getting good insurance, or will this be considered a "pre-existing condition?"Yikes! Insurance!Thanks,------------------------------------

[Guest guest]

HI ,Iam

From: <brookestarling@ hotmail.com>Subject: ( ) insurance Date: Friday, December 4, 2009, 12:48 AM

BCBS is offering 100% coverage for Noah up till age 7 for OT, speech, supplements and ABA if we have an autism diagnosis. I thought that this would be an option for us until I read our assessment report again tonight. Here's what it states:"Noah evidenced multiple characteristics commonly associated with Autism such as..... (list of symptoms)""Overall, in comparison to other children with autism of the same age, Noah shows some atypical development and features of autism. However, because placement in the Barron ECS will be his first school placement, an identification of Autism is being deferred. Instead, Noah will qualify for special ed services as a student with a Non-Categorical Early Childhood eligibility with a suspicion of an Autism Spectrum Disorder and a Speech Impairment." My questions are:1) Do we have an autism diagnosis that will qualify us for services w/

insurance, should we choose to go this route?2) Does anyone recommend going the autism route and taking our chances after age 7? (Any ideas about what do to then?) Or is it better to fly under the radar w/ encephalopothy, apraxia, etc? The law states that we would get full coverage until age 7. What would happen after that? Does anyone know if this will affect Noah when he is grown in getting good insurance, or will this be considered a "pre-existing condition?"Yikes! Insurance!Thanks,------------ --------- --------- ------

[Guest guest]

Hi i am in michigan,very instrested,what is BCBS,and is that only for puplic school kids not homeschooled kid.thanks

From: <brookestarling@ hotmail.com>Subject: ( ) insurance Date: Friday, December 4, 2009, 12:48 AM

BCBS is offering 100% coverage for Noah up till age 7 for OT, speech, supplements and ABA if we have an autism diagnosis. I thought that this would be an option for us until I read our assessment report again tonight. Here's what it states:"Noah evidenced multiple characteristics commonly associated with Autism such as..... (list of symptoms)""Overall, in comparison to other children with autism of the same age, Noah shows some atypical development and features of autism. However, because placement in the Barron ECS will be his first school placement, an identification of Autism is being deferred. Instead, Noah will qualify for special ed services as a student with a Non-Categorical Early Childhood eligibility with a suspicion of an Autism Spectrum Disorder and a Speech Impairment." My questions are:1) Do we have an autism diagnosis that will qualify us for services w/

insurance, should we choose to go this route?2) Does anyone recommend going the autism route and taking our chances after age 7? (Any ideas about what do to then?) Or is it better to fly under the radar w/ encephalopothy, apraxia, etc? The law states that we would get full coverage until age 7. What would happen after that? Does anyone know if this will affect Noah when he is grown in getting good insurance, or will this be considered a "pre-existing condition?"Yikes! Insurance!Thanks,------------ --------- --------- ------

[Guest guest]

Blue Cross Blue Shield...

From: <brookestarling@ hotmail.com>Subject: ( ) insurance Date: Friday, December 4, 2009, 12:48 AM

BCBS is offering 100% coverage for Noah up till age 7 for OT, speech, supplements and ABA if we have an autism diagnosis. I thought that this would be an option for us until I read our assessment report again tonight. Here's what it states:"Noah evidenced multiple characteristics commonly associated with Autism such as..... (list of symptoms)""Overall, in comparison to other children with autism of the same age, Noah shows some atypical development and features of autism. However, because placement in the Barron ECS will be his first school placement, an identification of Autism is being deferred. Instead, Noah will qualify for special ed services as a student with a Non-Categorical Early Childhood eligibility with a suspicion of an Autism Spectrum Disorder and a Speech Impairment." My questions are:1) Do we have an autism diagnosis that will qualify us for services w/

insurance, should we choose to go this route?2) Does anyone recommend going the autism route and taking our chances after age 7? (Any ideas about what do to then?) Or is it better to fly under the radar w/ encephalopothy, apraxia, etc? The law states that we would get full coverage until age 7. What would happen after that? Does anyone know if this will affect Noah when he is grown in getting good insurance, or will this be considered a "pre-existing condition?"Yikes! Insurance!Thanks,------------ --------- --------- ------

[Guest guest]

Blue Cross will require an absolute diagnosis from your healthcare provider

(your doctor). As far as pre-existing, you will need to keep insurance on your

child with no lapse in coverage. If you have a lapse in coverage for more than

63 days your insurance carrier can say they will not cover pre-existing

conditions, or there will be a waiting period before pre-existing conditions

will be covered (usually around a year) or they can put a " rider " on your policy

that will state that this condition will not be covered at all. It all depends

on your policy. You can always try to put your child on your state medicaid or

apply for disability. SSI (disability) is income based (on the parents income)

but your child will have SSI medicaid that will cover all services. feel free

to email me or post again on here if you have additional questions, My child has

a diagnosis of Asperger's ADD/ADHD, and we qualified for SSI!!

Hope this helps,

Cheryl

>

>

> From: <brookestarling@ hotmail.com>

> Subject: ( ) insurance

>

> Date: Friday, December 4, 2009, 12:48 AM

>

>

> BCBS is offering 100% coverage for Noah up till age 7 for OT, speech,

supplements and ABA if we have an autism diagnosis.  I thought that this would

be an option for us until I read our assessment report again tonight.  Here's

what it states:

>

> " Noah evidenced multiple characteristics commonly associated with Autism such

as..... (list of symptoms) "

>

> " Overall, in comparison to other children with autism of the same age, Noah

shows some atypical development and features of autism.  However, because

placement in the Barron ECS will be his first school placement, an

identification of Autism is being deferred.  Instead, Noah will qualify for

special ed services as a student with a Non-Categorical Early Childhood

eligibility with a suspicion of an Autism Spectrum Disorder and a Speech

Impairment. "

>

> My questions are:

>

> 1) Do we have an autism diagnosis that will qualify us for services w/

insurance, should we choose to go this route?

>

> 2) Does anyone recommend going the autism route and taking our chances after

age 7?  (Any ideas about what do to then?)  Or is it better to fly under the

radar w/ encephalopothy, apraxia, etc?

>

> The law states that we would get full coverage until age 7.  What would happen

after that?  Does anyone know if this will affect Noah when he is grown  in

getting good insurance, or will this be considered a " pre-existing condition? "

>

> Yikes!  Insurance!

> Thanks,

>

>

>

>

>

>

> ------------ --------- --------- ------

>

>

[Guest guest]

Does anyone know a good way to get insurance (Cigna) to pay for Speech Therapy

with speech apraxia as the diagnosis? They are denying payment stating that

speech apraxia is not a neurological or medical diagnosis and that speech

therapy would be considered " nonrestorative " !!

[Guest guest]

are you in california

On Thu, Mar 24, 2011 at 3:03 PM, <ecckwalk@...> wrote:

>

>

> Can anyone give me the name of their insurance group if they will cover

> treatment for Lyme, Babesia and/or Bartonella? Mine is denying all three but

> a few people have told me theirs will cover. Maybe you should email me

> privately w/ the names. ecckwalk@...

> thanks,

> Elaine

>

>

>

[Guest guest]

Oregon, but I'm still curious about other states.

________________________________

From: le Handy <kndplus2@...>

Sent: Thu, March 24, 2011 4:44:28 PM

Subject: Re: [ ] Insurance

are you in california

On Thu, Mar 24, 2011 at 3:03 PM, <ecckwalk@...> wrote:

>

>

> Can anyone give me the name of their insurance group if they will cover

> treatment for Lyme, Babesia and/or Bartonella? Mine is denying all three but

> a few people have told me theirs will cover. Maybe you should email me

> privately w/ the names. ecckwalk@...

> thanks,

> Elaine

>

>

>

[Guest guest]

I think this is a great idea....we should know which insurance companies that

treat and which ones do not....Meritain Health which has PHCS network or Private

Health Care Systems told us to check into lyme and they were paying for

treatment.  Our insurance was switched to Anthem Blue Cross and Blue Shield and

they denied all treatment.  This is the worst insurance company and they have a

policy to not pay for treatment.  One of the docs there told a friend's

neurologist that even if he says the person needs IV meds they will override him

and still not pay.  Regards, Dolores

>

>

> Can anyone give me the name of their insurance group if they will cover

> treatment for Lyme, Babesia and/or Bartonella? Mine is denying all three but

> a few people have told me theirs will cover. Maybe you should email me

> privately w/ the names. ecckwalk@...

> thanks,

> Elaine

>

> 

>

[Guest guest]

wah. We have anthem blue cross, for which we pay $1700 per month for four of us

(they had to offer us continuation coverage after our 3 years of COBRA were up

-- it's the law), and they will not pay most non-generics. We have had good

luck with the $25 manufacturer cards for Doryx and such, but it has been very

expensive. Ours is a PPO plan. They never covered Rocephin, though they claimed

they would for one month (after appeal from a reviewing doc who said it was not

necessary, not noticing that she had never been on it before and the policy is

to allow one month per that terrible article that IDSA put out).

I am curious about the Major Risk Insurance group. I think because we " qualify "

for this $1700 insurance ,we cannot get MRMIP.

________________________________

From: le Handy <kndplus2@...>

Sent: Fri, March 25, 2011 6:10:54 PM

Subject: Re: [ ] Insurance

i have anthem blue cross but i am in california and i get it through the

Major Risk Medical Insurance Program (MRMIP) which anyone who has been

denied insurance can apply for. they have covered ALL my oral abx for the

last two years in addition to all my tests (MRI,CAT, bloodwork, lots of

neurological testing etc.) i guess they have to since it is this program.

On Fri, Mar 25, 2011 at 3:56 AM, Dolores Claesson <dclaesson@...>wrote:

>

>

> I think this is a great idea....we should know which insurance companies

> that treat and which ones do not....Meritain Health which has PHCS network

> or Private Health Care Systems told us to check into lyme and they were

> paying for treatment. Our insurance was switched to Anthem Blue Cross and

> Blue Shield and they denied all treatment. This is the worst insurance

> company and they have a policy to not pay for treatment. One of the docs

> there told a friend's neurologist that even if he says the person needs IV

> meds they will override him and still not pay. Regards, Dolores

>

>

>

>

> >

> >

> > Can anyone give me the name of their insurance group if they will cover

> > treatment for Lyme, Babesia and/or Bartonella? Mine is denying all three

> but

> > a few people have told me theirs will cover. Maybe you should email me

> > privately w/ the names. ecckwalk@...

> > thanks,

> > Elaine

> >

> >

> >

>

>

[Guest guest]

you only qualify for MRMIP if you have been denied from insurance co. i also

have the ppo and used it extensively to go from specialist to specialist

before i knew what i had. i pay $650 just for myself but i am actually

saving money.

On Fri, Mar 25, 2011 at 6:23 PM, Natasha Moiseyev

<nmoiseyev@...>wrote:

>

>

> wah. We have anthem blue cross, for which we pay $1700 per month for four

> of us

> (they had to offer us continuation coverage after our 3 years of COBRA were

> up

> -- it's the law), and they will not pay most non-generics. We have had good

>

> luck with the $25 manufacturer cards for Doryx and such, but it has been

> very

> expensive. Ours is a PPO plan. They never covered Rocephin, though they

> claimed

> they would for one month (after appeal from a reviewing doc who said it was

> not

> necessary, not noticing that she had never been on it before and the policy

> is

> to allow one month per that terrible article that IDSA put out).

>

> I am curious about the Major Risk Insurance group. I think because we

> " qualify "

> for this $1700 insurance ,we cannot get MRMIP.

>

> ________________________________

>

> From: le Handy <kndplus2@...>

>

> Sent: Fri, March 25, 2011 6:10:54 PM

>

> Subject: Re: [ ] Insurance

>

> i have anthem blue cross but i am in california and i get it through the

> Major Risk Medical Insurance Program (MRMIP) which anyone who has been

> denied insurance can apply for. they have covered ALL my oral abx for the

> last two years in addition to all my tests (MRI,CAT, bloodwork, lots of

> neurological testing etc.) i guess they have to since it is this program.

>

> On Fri, Mar 25, 2011 at 3:56 AM, Dolores Claesson <dclaesson@...

> >wrote:

>

> >

> >

> > I think this is a great idea....we should know which insurance companies

> > that treat and which ones do not....Meritain Health which has PHCS

> network

> > or Private Health Care Systems told us to check into lyme and they were

> > paying for treatment. Our insurance was switched to Anthem Blue Cross and

> > Blue Shield and they denied all treatment. This is the worst insurance

> > company and they have a policy to not pay for treatment. One of the docs

> > there told a friend's neurologist that even if he says the person needs

> IV

> > meds they will override him and still not pay. Regards, Dolores

> >

> >

> >

> >

> > >

> > >

> > > Can anyone give me the name of their insurance group if they will cover

> > > treatment for Lyme, Babesia and/or Bartonella? Mine is denying all

> three

> > but

> > > a few people have told me theirs will cover. Maybe you should email me

> > > privately w/ the names. ecckwalk@...

> > > thanks,

> > > Elaine

> > >

> > >

> > >

> >

> >

[Guest guest]

We have Anthem Blue Cross Blue Shield PPO. We (me and my 7 year old daughter)

were only diagnosed in October, 2010, so we are still only doing oral abx. and

only treating for Lyme as far as we know. I think it also has to do with your

" prescription insurance " which is sometimes a different company. I think our

prescription ins. is Caremark.

After paying for my IGenex tests, the insurance rep. I spoke with to get the

instructions for submitting for reimbursement mentioned that " too bad I didn't

get prior authorization for IGenex to be considered an in-network lab " since it

is one of the few that specializes in tick borne illnesses, and there were no

labs specific to meet our needs in the network. I hung up and did exactly that

before we did my daughters testing. They paid 70% (minus co-insurance and

deductible) for mine. For my daughters testing, they paid out at 100%, of

course, it was minus co-insurance which is is different than co-payment, the

total was about $1,100, and we got back something like $850.00. Of course they

never got my first fax, I had to resubmit, then they processed as out of

network, I called and reminded them that I had received authorization for it to

be considered in network and that I had included a copy of that letter as well

with my request. The initial claim took 30 days before we got a check, when I

called to tell them they had processed incorrectly as out of network, instead of

" in-network " - we got a second check with the difference in less than a week

from my phone call.

.

From: dclaesson@...

Date: Fri, 25 Mar 2011 03:56:21 -0700

Subject: Re: [ ] Insurance

I think this is a great idea....we should know which insurance companies

that treat and which ones do not....Meritain Health which has PHCS network or

Private Health Care Systems told us to check into lyme and they were paying for

treatment. Our insurance was switched to Anthem Blue Cross and Blue Shield and

they denied all treatment. This is the worst insurance company and they have a

policy to not pay for treatment. One of the docs there told a friend's

neurologist that even if he says the person needs IV meds they will override him

and still not pay. Regards, Dolores

>

>

> Can anyone give me the name of their insurance group if they will cover

> treatment for Lyme, Babesia and/or Bartonella? Mine is denying all three but

> a few people have told me theirs will cover. Maybe you should email me

> privately w/ the names. ecckwalk@...

> thanks,

> Elaine

>

>

>

[Guest guest]

Good for you!

________________________________

From: Guillen <lovingmama@...>

<Lyme Treatment >

Sent: Sun, March 27, 2011 2:28:14 AM

Subject: RE: [ ] Insurance

We have Anthem Blue Cross Blue Shield PPO. We (me and my 7 year old daughter)

were only diagnosed in October, 2010, so we are still only doing oral abx. and

only treating for Lyme as far as we know. I think it also has to do with your

" prescription insurance " which is sometimes a different company. I think our

prescription ins. is Caremark.

After paying for my IGenex tests, the insurance rep. I spoke with to get the

instructions for submitting for reimbursement mentioned that " too bad I didn't

get prior authorization for IGenex to be considered an in-network lab " since it

is one of the few that specializes in tick borne illnesses, and there were no

labs specific to meet our needs in the network. I hung up and did exactly that

before we did my daughters testing. They paid 70% (minus co-insurance and

deductible) for mine. For my daughters testing, they paid out at 100%, of

course, it was minus co-insurance which is is different than co-payment, the

total was about $1,100, and we got back something like $850.00. Of course they

never got my first fax, I had to resubmit, then they processed as out of

network, I called and reminded them that I had received authorization for it to

be considered in network and that I had included a copy of that letter as well

with my request. The initial claim took 30 days before we got a check, when I

called to tell them they had processed incorrectly as out of network, instead of

" in-network " - we got a second check with the difference in less than a week

from my phone call.

.

From: dclaesson@...

Date: Fri, 25 Mar 2011 03:56:21 -0700

Subject: Re: [ ] Insurance

I think this is a great idea....we should know which insurance companies

that treat and which ones do not....Meritain Health which has PHCS network or

Private Health Care Systems told us to check into lyme and they were paying for

treatment. Our insurance was switched to Anthem Blue Cross and Blue Shield and

they denied all treatment. This is the worst insurance company and they have a

policy to not pay for treatment. One of the docs there told a friend's

neurologist that even if he says the person needs IV meds they will override him

and still not pay. Regards, Dolores

>

>

> Can anyone give me the name of their insurance group if they will cover

> treatment for Lyme, Babesia and/or Bartonella? Mine is denying all three but

> a few people have told me theirs will cover. Maybe you should email me

> privately w/ the names. ecckwalk@...

> thanks,

> Elaine

>

>

>