Posted 7/30/2015 4:25 AM (GMT 0)
Sonne, before you get another blood draw (and likely pay for the test out of pocket) check the website of your insurance company to see what hoops you have to jump through to get coverage.
Mine is Aetna and when I checked their Coverage Policy bulletin said that to be covered I would have to test positive or indeterminate on an ELISA. After that (and only that) they would pay for a Western Blot. If the test result on the Western Blot was positive (using the CDC criteria), then they would pay for treatment. The Bulletin went on for a page and a half about the treatment they wouldn't cover. The reason for everyone was "considered experimental". Essentially, the only thing they covered is a course (maybe two) of doxycycline. They wouldn't even pay for the Western Blot if the ELISA was negative.
I called around and searched the internet and found that Labcorp doesn't even do the ELISA, although I assume that the IFA is an accepted substitute.
I wouldn't keep spending money trying to get a test result when they won't pay for treatment. I also expect that they would challenge the results anyway given you have already had negative results.
Insurance companies suck, but they have time on their hands and will go to great lengths to avoid paying.
It's not fair. I spent two and a half years fighting for disability benefits. I had paid premiums out of my own pocket in addition to my company paying. Their (and SSA's) standard practice is to out wait you. People give up because they are too sick to fight. I'm really stubborn and i fought them every step of the way. Eventually, I won only to find out that not only were they entitled to repayment when I was approved for SSD, but since I had children under 18 they claimed their benefits too. My children's benefits were not mine to give away, so I had to pay out of my pocket. My employer signed the contract on my behalf and I was bound to it. In addition, the contract limited benefits for some conditions to 6 months Short Term Disability and 2 years Long term disability. The "conditions" were so none specific they could be interpreted to be anything. It took so long to get approval that I got two checks, one big one for 29 months and one check for the last month. Two months later they sent me a bill because "by now you have been approved for SSD and we calculate your benefit to be $XXX". Not. It took another 2 years to get an SSD approval and quite a while for the office that does payment to figure out how much they owed me and another 6 months to determine I had kids under 18 and how much they were owed.
Don't expect anything from an insurance company and make sure you know about all the fine print they use to get out of paying valid claim.
Sorry to be a downer, but I want to save you time, money and aggravation.
I hope that I'm wrong and they will pay, but please check it out before repeating a test they won't pay for and a claim they won't pay for.
Just to give you an idea of how bad they are, when my kids were younger and had chronic ear infections and chronic strep, I noticed that Aetna denying every claim under $100. I would have to have the doctor's office resubmit the claims. They figured since it was so "small" a bill we would just pay for it and I'm sure many people did.
I found out much to my surprise that the department that makes the decisions didn't have any phones. They couldn't call out and they couldn't receive calls. I also found out that they owed my Pediatricians office over $200,000. The pediatrician was dropping Aetna.
i complained to my boss only to find out that he and just about every employee at our location used the same pediatrician. My complaint went up the chain and eventually they made the decision that given the practice was the largest in the county, it was reasonable to say that we no longer had medical coverage. There was also an issue with an oncology practice.
They allowed us to make a change mid year. Aetna came in to talk to employees and the idiot tried to tell me I was wrong. I asked him if he wanted to see the 3 years worth of EOBs with every claim under $100 denied, sometimes twice. I walked out, followed by a fellow employee who also had a chronically ill child. He had the same experience. It was only those of us who had lots of bills that noticed the pattern. We changed companies.
Unfortunately, I'm stuck with Aetna again because my husband works remotely and we're the only non-CA employee. But I don't think in this case it would be any different.
Sorry to go on and on, it's one of my soap boxes.
I wish you the best of luck in this and I hope things work out differently for you.
I hope you have a good day,
Kim