Lymebabe,
Please email me, I would love to talk to you. I also have a toll free number I can give you.
I really like the fact that they do so many test and retest. I think that is a good thing. I have tried to get my insurance to do a Gap Coverage on this put I am in the appeal process. I understand they probably will not pay for it. However, I don't know if you have see the following article or not.
Insurance
How to Respond to
Insurance Denials
Based on IDSA Guidelines
Lorraine Johnson, JD,
MBA, Chief Executive Officer, California Lyme Disease Association
Now that the
Connecticut Attorney General has released his findings of the antitrust
investigation into the IDSA guidelines, what should you do about insurance
denials? If you are denied insurance coverage for Lyme disease based on the
IDSA guidelines, you should:
- Send your insurer a letter objecting to the denial. Point out that the Connecticut Attorney General found
the IDSA guidelines were seriously flawed and that the IDSA “allow[ed]
individuals with financial interests—in drug companies, Lyme disease
diagnostic tests, patents and consulting arrangements with insurance
companies—to exclude divergent medical evidence and opinion”,
specifically, evidence and opinions supporting the diagnosis and treatment
of chronic Lyme disease. See sample attached.
- Attach a copy of the Attorney General’s press release
to the letter. See attached press release or go to: www.ct.gov/ag/cwp/view.asp?a=2795&q=414284
- Send your State Attorney General a copy of your letter
to your insurance company.
You can locate your state Attorney General’s address at www.naag.org/attorneys_general.php
What do you do if your
insurer does not respond to this request? Take it from Joanna Smith, a patient
advocate who runs Healthcare Liaison Inc. in Berkeley, says "I always say
to people appeal, appeal, appeal," she said. "And then appeal
again." Follow all of your internal and external rights of appeal and call
your state Attorney General to complain about your insurer. Although this will
not always work, Attorneys’ General are becoming more active and more concerned
about health care denials. Your job is to let them know your health care
insurer is denying you medical care based on flawed guidelines that are under
attack.
Anyway, that is why I am appeal. I figure I might as well try. I do have an appointment with LLMD in my area in April so I want to see what he has to say. But, I am really leaning towards Sponaugle. 