Guest guest Posted December 20, 2000 Report Share Posted December 20, 2000 Rhonna, You need a lawyer. Rita B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2000 Report Share Posted December 20, 2000 Rhonna wrote: Back to the problem...I received a letter from my insurance company this week and they are requesting that I see one of two doctors for a second opinion. Now the two doctors that I get to choose from are two doctors that I have seen in the past that both said that my illness was " all in my head " . Hence my problem. I never want to see either of these doctors again let alone let them have such an influence on my life. Any suggestions on how to fight this? Thanks for any help you can provide, Hi Rhonna, Please immediately consult with an attorney -- I'll pay for the consultation. I think there is the possibility that you are being severely damaged by the insurance company. In such a case, the attorney may take it on a contingency basis. Otherwise, get a cost estimate for obtaining an injunction against the insurance company. I'll be talking with you. Jack Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2000 Report Share Posted December 20, 2000 Rhonna- I'm not sure about how to avoid having to see one of these doctors, maybe the suggestion of a lawyer is a good one. But, when confronted with a similar issue with my ins. co., I was counseled by the insurance ombudsman of the state that I needed to consent to go to the consultation. This was as part of my appealing the ins.co's refusal to pay benefits for my out-of-network LLMD. I eventually won the appeal, and they now cover my LLMD at the same rate they cover in-network doctors. So if you do have to go to a 'second opinion' consultation with an ID doc, the following would be my strategy (for what it's worth) based on what worked for me: The insurance companies have to provide quality of care and a doctor who has " **'current competence'** according to the prevailing standard of care. " Now, this is part of the insurance code and law of Virginia, so you need to make sure that's true where you are, but my guess is that it's pretty standard. Okay- my strategy was to prove this doctor did not have **current competence** in the field of treating **chronic** lyme disease. [Now, it may have helped that after being ill for 8 years I was recently positive by PCR (it's important to get serial PCR's if you go that route). Do you have any positive tests, old or new? A recent LUAT?] The important points here, IMHO, are that you have *chronic* LD, and that you can demonstrate the doctor you are sent to does not have *current competence* in the field of treating chronic lyme disease. There are several ways to go about doing this having to do with the type of questions *you ask him* at the consultation. These questions have to do with how many patients with chronic LD is he currently treating, is he going to lyme conferences and which ones, does he know about the different theories of persistence of infection (you have to have done your homework), does he know about the newest medications being used and why(flagyl, questran, etc.). Is he up on the most current literature? is he up on the tests? and the problems? How would he treat you and why? There are some other questions I would probably ask while I was there, and some other things.. like be cooperative, but ask all your questions and **write down the answers**. If you aren't well enough to handle it with him, bring someone who can do it with you.. perhaps, a family member you trust. Then, you have to take all of this information and write a letter to the insurance co. documenting your meeting with him, your problems with his being a consultant on your case, etc., etc. The first question is though-- Can you avoid having to go see this doctor in the first place? You need to be careful about answering this question.. if you are not going to cooperate, can they retaliate, throw you out, etc. A lawyer would be able to tell you this.. or the State Commission's Bureau of Insurance ombudsman may be able to help you with this.. you should find out who this, contact him, and see if he is friendly. It is their job to try to help resolve insurance issues equitably.. at least, that's my understanding. The ombudsman here was pretty helpful. Hope that helps-- if you need more info, email. Lainie [ ] Insurance problems > Hi all-- > My insurance company, which up until now, had been very cooperative with > the treatment that I have been receiving for the past 3 1/2 years for > lyme. I was pulled from what I believe was the brinks of death by my > llmd. Ironically, I only found him because I went to visit my mother > who lived near him, and when I could not find my way to her house from > the interstate (my parents had lived there 13 years!), she convinced me > to see this wonderful doctor who I believe saved my life. > Back to the problem...I received a letter from my insurance company this > week and they are requesting that I see one of two doctors for a second > opinion. Now the two doctors that I get to choose from are two doctors > that I have seen in the past that both said that my illness was " all in > my head " . Hence my problem. I never want to see either of these > doctors again let alone let them have such an influence on my life. > Any suggestions on how to fight this? > Thanks for any help you can provide, > Rhonna in Ohio > > > > HAPPY HOLIDAYS!!! > > > Easy Reference: > Send a blank email message to: > > -Subscribeegroups - Subscribe to the list through email > -Unsubscribeegroups - Unsubscribe from the list > -Digestegroups - Switch your subscription to a digest format > -Normalegroups - Switch your subscription to normal > > Please send messages not related to Lyme disease (this includes humor) to -Offtopicegroups > > Archives can be accessed at lyme-aid > > Please visit the sister site at > http://clubs./clubs/lymeaid > This is the primary chat site for . > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2000 Report Share Posted December 20, 2000 Whoops! LOL I didn't mean to post that to the group.. This is the one I meant to post to the group.. Have a good laugh, but I think it worth thinking about: I think I have some information that might be helpful with your problem, but I am hesitant to post all of the details on an open list. I will email you privately with some suggestions. Do we need to think about how we can share this kind of information in a secure way. Almost all of us have insurance problems, but we can't be sure who might be monitoring our open boards.. Just a thought.. Lainie You wrote: > Back to the problem...I received a letter from my insurance company this > week and they are requesting that I see one of two doctors for a second > opinion. Now the two doctors that I get to choose from are two doctors > that I have seen in the past that both said that my illness was " all in > my head " . Hence my problem. I never want to see either of these > doctors again let alone let them have such an influence on my life. > Any suggestions on how to fight this? > Thanks for any help you can provide, > Rhonna in Ohio > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 11, 2010 Report Share Posted February 11, 2010 My company recently switched health insurance companies. The new prescription card is from Medco. My old insurance covered testosterone injections but my new insurance doesn't. How does this work? They don't seem to cover any testosterone injections. Has anyone else experienced this with Medco? Quote Link to comment Share on other sites More sharing options...
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