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Sara,

That was quite well written....they can not have it both ways....Regards,

Dolores

> When you are getting new insurance. What do you tell them on the application

since Chronic Lyme isn't really a valid DX in many medical professionals eyes? I

don't want to be cancelled for lying but if I don't lie they are either going to

deny us altogether or allow us but not cover my meds for however long they

decide.

>

> I'm on a bunch of different meds for abx, pain, and such so I need those

covered-I can't afford to pay for those out of pocket. My LLMD of course doesn't

take insurance so they won't have to pay for that.

>

> Do I list my condition or just my meds? Do I just say I don't know what I

have? What do you all do?

>

>

>

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

>

> Lyme Disease News continually updated from thousands of sources around the

> net: http://www.topix.net/health/lyme-disease

>

> MedWorm: The latest items on: Lyme Disease

> http://tinyurl.com/23dgy8

>

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United Health Care covered my Lyme treatment (LLMD visits,oral meds for 8

months & PICC line procedure and one month of Ceftriaxone & visiting RN for

dressing changes). After the one month of IV Ceftriaxone (Rocephin) I received

notification that beyond the one month was considered " experimental. "

Experimental treatment is not covered under my policy (which is typical). Now

they won't pay for my visits or IV meds, supplies or dressing changes. In 18

months I'm off COBRA coverage and have to go on the open market as an individual

in Massachusetts.

My question is if the denial is based on " experimental " nature of treatment (per

IDSA, CDC, NIH opinions) what should I put on the questionnaire for new

insurance? I wish I knew a health insurance adviser, I'd pay for help filling

out the form. I have a complicated history with some misdiagnoses.

Kim

Re: [ ] Insurance

Sara,

That was quite well written....they can not have it both ways....Regards,

Dolores

> When you are getting new insurance. What do you tell them on the application

since Chronic Lyme isn't really a valid DX in many medical professionals eyes? I

don't want to be cancelled for lying but if I don't lie they are either going to

deny us altogether or allow us but not cover my meds for however long they

decide.

>

> I'm on a bunch of different meds for abx, pain, and such so I need those

covered-I can't afford to pay for those out of pocket. My LLMD of course doesn't

take insurance so they won't have to pay for that.

>

> Do I list my condition or just my meds? Do I just say I don't know what I

have? What do you all do?

>

>

>

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

>

> Lyme Disease News continually updated from thousands of sources around the

> net: http://www.topix.net/health/lyme-disease

>

> MedWorm: The latest items on: Lyme Disease

> http://tinyurl.com/23dgy8

>

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Kim,

Are you aware that many folks with Chronic Lyme have successfully gotten

their disease into remission without antibiotics or costly doctor office

visits? (My wife is one such!) Some of the regimens used are Salt/C, CS,

Rife and many others.

I document a lot of this on my free lyme resource CD. See below if you would

like a free copy.

Just things to think about! Remember its your body, your health and

ultimately you are the one responsible for choosing how it is treated!

www.lyme-resource.com

You can lead a person to a fact, but you can't make them think! -

> Re: [ ] Insurance

>

>

>

>

>

> Sara,

> That was quite well written....they can not have it both

> ways....Regards, Dolores

>

>

>

> > When you are getting new insurance. What do you tell them

> on the application since Chronic Lyme isn't really a valid DX

> in many medical professionals eyes? I don't want to be

> cancelled for lying but if I don't lie they are either going

> to deny us altogether or allow us but not cover my meds for

> however long they decide.

> >

> > I'm on a bunch of different meds for abx, pain, and such so

> I need those covered-I can't afford to pay for those out of

> pocket. My LLMD of course doesn't take insurance so they

> won't have to pay for that.

> >

> > Do I list my condition or just my meds? Do I just say I

> don't know what I have? What do you all do?

> >

> >

> >

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

> >

> > Lyme Disease News continually updated from thousands of

> sources around

> > the

> > net: http://www.topix.net/health/lyme-disease

> >

> > MedWorm: The latest items on: Lyme Disease

> > http://tinyurl.com/23dgy8

> >

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Guest guest

There is help for insurance denials on the CALDA website, including a

letter template. Look under Resources/Insurance. There is also a special

insurance issue of the Lyme Times. Look under Lyme Times.

Phyllis Mervine

CALDA

Empowering Patients Through Advocacy, Education & Research

www.lymedisease.org

--

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  • 2 months later...

I think that means are you covered under any other policy such as a spouse's group coverage

Helen

In a message dated 9/4/2010 1:32:50 P.M. Eastern Daylight Time, everystep8@... writes:

Hi all,I am completing a prescription claim for to send my insurance hoping they would cover my LDN. One of the questions is: "Is this medication covered under any other group insurance policy!". If you had your insurance cover LDN, please let me know which one. Thank you!

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Why don't you try going to your insurance company's website and check their formulary.You will find out immediately if they cover naltrexone - not low dose naltrexone which I very much doubt they will cover - and how much your copay is.Some people do get their docs to prescribe the 50 mg tabs for them. Then they make it into the liquid LDN many of us use.But I have never heard of LDN being covered by insurance - it's possible though, and I hope you do get an affirmative response or responses.jackieFrom: everystep8 <everystep8@...>Subject: [low dose naltrexone]

Insurancelow dose naltrexone Date: Saturday, September 4, 2010, 12:32 PMHi all,I am completing a prescription claim for to send my insurance hoping they would cover my LDN. One of the questions is: "Is this medication covered under any other group insurance policy!". If you had your insurance cover LDN, please let me know which one. Thank you!------------------------------------

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I live in New York and have Empire Blue Cross medical insurance. I am told by

them they will cover the cost of LDN only if I use one of their approved

pharmacies. I prefer to use Skip's Pharmacy in Florida and they're not on that

list so I pay for it myself, only $25.00 a month.

Art

My MS/LDN story/1988 - 2010

http://ldn.proboards.com/index.cgi?board=personal & action=display & thread=867

--

>

> Hi all,

> I am completing a prescription claim for to send my insurance hoping they

would cover my LDN. One of the questions is: " Is this medication covered under

any other group insurance policy! " . If you had your insurance cover LDN, please

let me know which one. Thank you!

>

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I also think that the question about LDN being covered by any other insurance

policy is asking whether you are covered under more than one policy.

That's what it means on our insurance form, anyway.

Our insurance, Sunlife, covered LDN. No questions asked. But I'm in Canada.

Jaye

>

> Hi all,

> I am completing a prescription claim for to send my insurance hoping they

would cover my LDN. One of the questions is: " Is this medication covered under

any other group insurance policy! " . If you had your insurance cover LDN, please

let me know which one. Thank you!

>

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On Sun, 05 Sep 2010 18:35:03 -0400, uxordepp <jprocure@...> wrote:> I also think that the question about LDN being covered by any other > insurance policy is asking whether you are covered under more than one > policy.>> That's what it means on our insurance form, anyway.>> Our insurance, Sunlife, covered LDN. No questions asked. But I'm in > Canada.>> Jaye>> >>>> Hi all,>> I am completing a prescription claim for to send my insurance hoping >> they would cover my LDN. One of the questions is: "Is this medication >> covered under any other group insurance policy!". If you had your >> insurance cover LDN, please let me know which one. Thank you!>>>Blue Cross. But there was a $40 co-pay (presumably because it has to be compounded.) I found it cheaper to simply pay for LDN without going through insurance.n______________________________A funny, touching gift book for cat lovers. Signed copies, free shipping (U.S., reduced elsewhere): Confessions of  a Cataholic: My Life With the 10 Cats Who Caused My Addiction by n Van Til www.wordpowerpublishing.com  

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As I recall, that question is asked whenever you file a claim. Say NO.

> >

> > Hi all,

> > I am completing a prescription claim for to send my insurance hoping they

would cover my LDN. One of the questions is: " Is this medication covered under

any other group insurance policy! " . If you had your insurance cover LDN, please

let me know which one. Thank you!

> >

>

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In many cases both spouses have access to group health insurance where they and their family members are listed as dependents or the insured. All they want to know is if you are listed on additional group coverage that processed a LDN prescription claim for you. Sometimes insurance companies just want to know if you you are covered on another plan...period.

My insurance is through Caremark....Irmat Pharmacy processes the claim. I have never been questioned about LDN. The pills are about .66 cents each for a 30 day supply.

I also think that the question about LDN being covered by any other insurance policy is asking whether you are covered under more than one policy.That's what it means on our insurance form, anyway.Our insurance, Sunlife, covered LDN. No questions asked. But I'm in Canada.Jaye>> Hi all,> I am completing a prescription claim for to send my insurance hoping they would cover my LDN. One of the questions is: "Is this medication covered under any other group insurance policy!". If you had your insurance cover LDN, please let me know which one. Thank you!>

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  • 5 months later...

I have not dealt with that yet - insurance has been good so far - but I do

believe if you go on www.lymedisease.org they have a place explaining how to

fight the insurance......even contact them and ask them as I am sure they have

dealt with this many times before.

Good luck and my prayers are with you - this disease is hard enough and then to

top it off having to fight for our meds........it makes me sick!!

bless you - Diane

________________________________

From: <ecckwalk@...>

Sent: Sun, February 27, 2011 11:15:53 PM

Subject: [ ] Insurance

 

Anyone have any experience getting their insurance to approve an antibiotic(s)?

My insurance approved Mepron the first time I took it, maybe a yr ago, but won't

approve it this time. They actually want to drop all of my antibiotic coverage

for Bab, Bart and Lyme. I'm surprised about the Bart and Bab because they are

less controversial. I've sent in my appeal. I've also sent my story, numerous

articles supporting long term treatment, dr's note, etc to our state legislature

and attorney general. Has anyone taken this to the next step-- beyond the first

appeal? Now I need to find more evidence for treatment of Bab in hopes of

getting my Mepron approved. Any advice?

thanks,

Elaine

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Due to the fact that they dictate their coverage according to the IDSA standards

and the CDC, you should cc them what is happening to you and that it is their

fault that you are going without treatment because of their decisions and

restrictions and you should blame all of them for your continued illness that

could potentially be fatal.

They need to allow people to decide with our doctors the best treatment and they

should not have the audacity to think they know better. I would demand a legal

statement from them that they are refusing your treatment. Even though you'll

never get one.

There is a chance it might be easier for them to cover it than to admit they are

responsible for your illness.

Suzanne

Sent from my iPhone

On Feb 27, 2011, at 11:15 PM, " " <ecckwalk@...> wrote:

> Anyone have any experience getting their insurance to approve an

antibiotic(s)? My insurance approved Mepron the first time I took it, maybe a yr

ago, but won't approve it this time. They actually want to drop all of my

antibiotic coverage for Bab, Bart and Lyme. I'm surprised about the Bart and Bab

because they are less controversial. I've sent in my appeal. I've also sent my

story, numerous articles supporting long term treatment, dr's note, etc to our

state legislature and attorney general. Has anyone taken this to the next step--

beyond the first appeal? Now I need to find more evidence for treatment of Bab

in hopes of getting my Mepron approved. Any advice?

> thanks,

> Elaine

>

>

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Hi I am here in FL and we are having huge issues with Anthem Blue Cross and Blue

Shield.

They are denying IV meds for lyme disease.  My whole family has been denied and

there is a mom and her 17 yr old boy who have been denied.  was in a

wheelchair unable to walk and the ID doc put him in the hospital right away and

gave him IV rocephin and he is now able to walk but still needs meds and Anthem

BC/BS has denied all meds even the ones the hospital administered.  Also his

mom got final denials from Anthem BC/BS for herself and the doc at insurance

told her neurologist that they both realize that she needs IV meds (lots of

brain lesions) and that he will be overruled so a doc at insurance can not give

say IV meds are required.  So much for independent reviews !!!!    This has

got to stop !!  Dolores

> Anyone have any experience getting their insurance to approve an

antibiotic(s)? My insurance approved Mepron the first time I took it, maybe a yr

ago, but won't approve it this time. They actually want to drop all of my

antibiotic coverage for Bab, Bart and Lyme. I'm surprised about the Bart and Bab

because they are less controversial. I've sent in my appeal. I've also sent my

story, numerous articles supporting long term treatment, dr's note, etc to our

state legislature and attorney general. Has anyone taken this to the next step--

beyond the first appeal? Now I need to find more evidence for treatment of Bab

in hopes of getting my Mepron approved. Any advice?

> thanks,

> Elaine

>

>

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Suzanne,

I like the idea of sending the cc to the CDC.  Do you mean demand a statement

from the CDC stating they are denying treatment or from my insurance?  The CDC

and IDSA do make statements on their websites (which I copied and included in my

appeal) that treatment should be determined by the treating physician but then

it seems the insurance only focuses on the IDSA's length of treatment.  So,

ultimatley, this problem is shared w/ the insurance agency.  THEY are trying

to

be the ones to determine treatment.  Nothing new though-- we all know this!

thanks,  Elaine

 

Due to the fact that they dictate their coverage according to the IDSA standards

and the CDC, you should cc them what is happening to you and that it is their

fault that you are going without treatment because of their decisions and

restrictions and you should blame all of them for your continued illness that

could potentially be fatal.

They need to allow people to decide with our doctors the best treatment and they

should not have the audacity to think they know better. I would demand a legal

statement from them that they are refusing your treatment. Even though you'll

never get one.

There is a chance it might be easier for them to cover it than to admit they are

responsible for your illness.

Suzanne

Sent from my iPhone

On Feb 27, 2011, at 11:15 PM, " " <ecckwalk@...> wrote:

> Anyone have any experience getting their insurance to approve an

antibiotic(s)?

>My insurance approved Mepron the first time I took it, maybe a yr ago, but

won't

>approve it this time. They actually want to drop all of my antibiotic coverage

>for Bab, Bart and Lyme. I'm surprised about the Bart and Bab because they are

>less controversial. I've sent in my appeal. I've also sent my story, numerous

>articles supporting long term treatment, dr's note, etc to our state

legislature

>and attorney general. Has anyone taken this to the next step-- beyond the first

>appeal? Now I need to find more evidence for treatment of Bab in hopes of

>getting my Mepron approved. Any advice?

> thanks,

> Elaine

>

>

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Thank you, Diane. Yes, that site has been helpful but I'm not expecting

anything.

Elaine

________________________________

From: Diane Biel <dkbmama@...>

Sent: Mon, February 28, 2011 5:01:15 AM

Subject: Re: [ ] Insurance

 

I have not dealt with that yet - insurance has been good so far - but I do

believe if you go on www.lymedisease.org they have a place explaining how to

fight the insurance......even contact them and ask them as I am sure they have

dealt with this many times before.

Good luck and my prayers are with you - this disease is hard enough and then to

top it off having to fight for our meds........it makes me sick!!

bless you - Diane

________________________________

From: <ecckwalk@...>

Sent: Sun, February 27, 2011 11:15:53 PM

Subject: [ ] Insurance

 

Anyone have any experience getting their insurance to approve an antibiotic(s)?

My insurance approved Mepron the first time I took it, maybe a yr ago, but won't

approve it this time. They actually want to drop all of my antibiotic coverage

for Bab, Bart and Lyme. I'm surprised about the Bart and Bab because they are

less controversial. I've sent in my appeal. I've also sent my story, numerous

articles supporting long term treatment, dr's note, etc to our state legislature

and attorney general. Has anyone taken this to the next step-- beyond the first

appeal? Now I need to find more evidence for treatment of Bab in hopes of

getting my Mepron approved. Any advice?

thanks,

Elaine

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Guest guest

I meant demand statement from insurance co. The CDC won't even listen to you.

I've had an insurance company tell me once how long it was going To take for my

back injury to heal over the phone. Lol. I asked her when she received her Phd

and how she determined that sight unseen. She quit talking after that.

Suzanne

Sent from my iPhone

On Feb 28, 2011, at 10:16 AM, <ecckwalk@...> wrote:

> Suzanne,

> I like the idea of sending the cc to the CDC. Do you mean demand a statement

> from the CDC stating they are denying treatment or from my insurance? The CDC

> and IDSA do make statements on their websites (which I copied and included in

my

> appeal) that treatment should be determined by the treating physician but then

> it seems the insurance only focuses on the IDSA's length of treatment. So,

> ultimatley, this problem is shared w/ the insurance agency. THEY are trying

to

> be the ones to determine treatment. Nothing new though-- we all know this!

> thanks, Elaine

>

>

> Due to the fact that they dictate their coverage according to the IDSA

standards

> and the CDC, you should cc them what is happening to you and that it is their

> fault that you are going without treatment because of their decisions and

> restrictions and you should blame all of them for your continued illness that

> could potentially be fatal.

>

> They need to allow people to decide with our doctors the best treatment and

they

> should not have the audacity to think they know better. I would demand a legal

> statement from them that they are refusing your treatment. Even though you'll

> never get one.

>

> There is a chance it might be easier for them to cover it than to admit they

are

> responsible for your illness.

>

> Suzanne

>

> Sent from my iPhone

>

> On Feb 27, 2011, at 11:15 PM, " " <ecckwalk@...> wrote:

>

> > Anyone have any experience getting their insurance to approve an

antibiotic(s)?

> >My insurance approved Mepron the first time I took it, maybe a yr ago, but

won't

> >approve it this time. They actually want to drop all of my antibiotic

coverage

> >for Bab, Bart and Lyme. I'm surprised about the Bart and Bab because they are

> >less controversial. I've sent in my appeal. I've also sent my story, numerous

> >articles supporting long term treatment, dr's note, etc to our state

legislature

> >and attorney general. Has anyone taken this to the next step-- beyond the

first

> >appeal? Now I need to find more evidence for treatment of Bab in hopes of

> >getting my Mepron approved. Any advice?

> > thanks,

> > Elaine

> >

> >

>

>

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Guest guest

The insurance denial road is a long one. I am the person that Dolores mentioned

in her post. Anthem could care less how sick my son and I are. I have sent peer

to peer lit to them at thier request.The appeal for the denial was never replied

to.The claim " we have no record of any appeal being recorded by you " . It isnt the

customer service dept,its the nurse manager review people. Oh and the dr's they

have on staff to review the claims..always always get names! Get the nurse,her

sup and any dr they say who reviewed your claim.

If anyone is lucky enough to live in a state that has legislation,remind the

insurance company of that. If there is legislation,contact your state attorney

general and file a complaint right away.

All the insurance companies are doing is adding insult to injury. What Dolores

said is true.the outside review dr said " even if I say she needs the IV

antibiotics they will be denied " . Now the bacteria is in my heart and I have

more brain lesions. SO much for being cured after 28 days of therapy huh?

Y

>

> > Anyone have any experience getting their insurance to approve an

antibiotic(s)? My insurance approved Mepron the first time I took it, maybe a yr

ago, but won't approve it this time. They actually want to drop all of my

antibiotic coverage for Bab, Bart and Lyme. I'm surprised about the Bart and Bab

because they are less controversial. I've sent in my appeal. I've also sent my

story, numerous articles supporting long term treatment, dr's note, etc to our

state legislature and attorney general. Has anyone taken this to the next step--

beyond the first appeal? Now I need to find more evidence for treatment of Bab

in hopes of getting my Mepron approved. Any advice?

> > thanks,

> > Elaine

> >

> >

>

>

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  • 4 weeks later...
Guest guest

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

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Guest guest

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

> >

> >

> >

>

>

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Guest guest

I received 100%......I did not need to get prier authorization but did contact

them anyways.  When I did summit to my insurance company I did also write a

letter stating that they should consider this in-network due to not having any

specialty labs in-network .... exactly how it was stated by - I was

happily shocked....kind of give me power to any doctor that might say that this

lab is inaccurate and should not be trusted and we need to use their

labs.....not as my insurance company paid.

Sorry - if this isn't making much sense as my brain isn't connecting today or

yesterday......orrr.......

Diane :)

________________________________

From: Guillen <lovingmama@...>

<Lyme Treatment >

Sent: Sun, March 27, 2011 4:28:14 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

>

> 

>

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  • 2 weeks later...
Guest guest

Hi Irma,

Bee lives in Canada where there is universal medical coverage, so I don't

imagine she would know about insurance companies in the States. Perhaps some of

your fellow American members can give you a hand with the better insurance

companies.

Good luck!

>

> Hi Bee,

> I was thinking that maybe I should get some type of insurance for

myself and my daughter. I know I'm healing at the moment and I don't think I'll

ever go back to Drs. But I still think it would be wise to carry

insurance.Especially now that I have a tooth ache I wish I would've had dental

insurance. So I decided I need to get it for emergency God forbid but sometimes

they just happen and I want to be prepared. Do you have any suggestion on some

insurance companies that I can look into. That would be very helpful.Thank you

Bee.

>

> Irma P

>

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