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submitting tests to insurance

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Posted 3/24/2012 6:57 PM (GMT 0)
Hello,

I was curious what your experiences have been with submitting tests to your insurance companies. I am concerned about doing so, because I don't want our insurance to know that we have lyme. I feel that if they do, they will not reimburse us for some of the tests and procedures that we need to go through. Have you sent your tests in to your insurance company for out-of-network reimbursement? How did they handle the situation? Did it end up being a mistake to do so?

Thank you for your help!
Posted 3/24/2012 8:57 PM (GMT 0)
I chose not to submit my Igenex tests or the CD57's that I get to insurance. I don't know if it's helping to prevent issues or not. I just didn't want to take any risks.
Posted 3/25/2012 1:25 AM (GMT 0)
Who is your insurance provider?

I know that with Blue Cross/Blue Shield and Harvard Pilgrim, they should be covered.

This is from my experience.

Posted 3/25/2012 8:45 PM (GMT 0)
We do have an insurance that will cover the tests. I'm just not sure if it's a good idea to let the insurance companies see those tests. I'm not sure if that will hurt are chances of getting covered for treatments, etc.

Thanks for your input.
Posted 3/25/2012 9:25 PM (GMT 0)
I don't understand. What is the risk with them knowing you have lyme?
Posted 3/26/2012 5:29 PM (GMT 0)
Well, I can tell you that I've submitted plenty of things to my insurance company - first time around 10 years ago, and again throughout the last 9 months, directly addressing the Lyme (I've even sent plenty of appeals to them for IV therapy) and there's never been a problem. I don't think they can discriminate like that.

The only thing that gets a little tricky is antibiotics. Like I said getting approved for IV can be tough, but as far as orals...BCBS uses medco as a mailaway pharmacy, meaning I'm required to get 3 months worth of maintanence meds at a time if I want insurance to cover them. After I believe 1 refill on my abx, it raised the red flag, and the decided they no longer have to cover my abx because BCBS still uses the IDSA guidelines, and I do wonder if the only reason they saw the red flag there was because I specifically told them that I have Lyme disease.

Otherwise though - submit away! That's what insurance companies are there for!!! (And mine has covered A LOT of my expenses!).
Posted 3/26/2012 8:49 PM (GMT 0)
I agree. If you are diagnosed by a doctor with lyme, they cannot deny you coverage for bills, tests, rx. However, that being said, BC/BS did deny me IV. They defined it as being experimental and wanted me to have a spinal tap to confirm diagnosis of lyme. I refused. I did appeal the decision but again was refused.

I have never (knock on wood) been denied coverage for anything since that. You pay for insurance so you should submit your bills. You are entitled to get them paid for.
Posted 3/26/2012 8:49 PM (GMT 0)
I agree. If you are diagnosed by a doctor with lyme, they cannot deny you coverage for bills, tests, rx. However, that being said, BC/BS did deny me IV. They defined it as being experimental and wanted me to have a spinal tap to confirm diagnosis of lyme. I refused. I did appeal the decision but again was refused.

I have never (knock on wood) been denied coverage for anything since that. You pay for insurance so you should submit your bills. You are entitled to get them paid for.
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