Scammed out of $$$

These appointment prices...just wow! Talk about GREED.

I was done with that six years ago, but it was $180 each time (30-45 min) for two years, including the initial longer first appt. Was no famous Dr, (now semi-retired) but the plan worked, a morning road trip a couple hundred miles, not across the country.

***To cut cost - that LLMD wrote blood draw "orders" that I took to my PCP or hospital where my insurance covered the lab tests. ANY LLMD should/can offer that.**

LLMD also did free blood draws for special tests not insurance covered.

I now consider myself lucky.

skinny_joe said...
Ive never heard of standard blood tests not being covered. For some reason the one arm doesnt talk to the other.

In the US- Most insurance companies will not cover an LLMD or ANYTHING done IN that clinic, even if state law says they have to (been through that, didnt matter).

Word gets out and insurance knows who does what per the visit notes sent in for appt coverage - no hiding that. Any hiding appt info is illegal. Insurance companies have been sued finally the last few years where law is applicable, thats when they finally pay IF the clinic was in network. They dont care until law forces them. Out of network, anything goes, you pay all of it.

As far as the right hand not talking to the left- my Rx meds scripted by the LLMD were insurance covered (with the co-pay).

The place doing the blood draw needs to be "in network" unless you have incredibly awesome insurance with no limitations. So you go someplace that is. My LLMD drew blood for me free on special tests that also had a clinical mark up. Another LLMD used a specific blood draw place that was ins covered, but test was not.

Gotta know the game, but a decent LLMD should explain the "rules" to people to save $.

For most of my adult life, once I started my first job out of college, I've had good employer-sponsored health and dental coverage. And, for people who need help within the "standard of care," that insurance can work fine for many issues.

Because my employers subsidized 80% or more of the policy cost, I always selected the most expensive plans available, as they had the lowest co-payments, had the lowest deductibles, and had the least restrictions. That was all fine, until I needed more from the healthcare system.

At some point, running the standard labs (e.g. CBC, CMP, lipids, etc.) over and over wasn't getting me anywhere, as none of those were the problem. That's when I started seeking out integrative/functional medicine doctors.

Like others here, I paid the high out-of-pocket costs, because these alternative doctors didn't accept insurance. I kept all the receipts and got CPT codes for anything I could, so I could submit the paperwork to my insurance company to request reimbursement.

Most of the time, my requests were denied, because the procedures were not considered valid or medically necessary. These determinations, I later found out, were made not by some doctor employed by the insurance company to review claims (which can happen), but by some non-medically-trained claims processor at the insurance company. (In the case where a doctor did review my claim and denied it, that was especially frustrating, as that doctor didn't know my full medical history.)

Once I learned to resubmit denied claims and request review by a higher level of authority by the insurance company, some of my claims -- which, again, had initially been denied -- were subsequently approved and reimbursed. There were also a few claims which I submitted that were "never received" by the insurance company. Luckily, I kept copies of everything sent, so I could submit the "missing" claims again.

This was a lot of paperwork, time, and follow up on my part.

Not only was there the need for me to make copies of the forms the alternative doctor's office provided to me (with dates, prices, CPT codes, NPI numbers, etc.), but I had to complete the claim form from the insurance company. Each form had to have all of the same information about the date of service, the provider's details, all my information, insurance plan number, etc. Omit or get even one of those items wrong and the entire submission could either stall or be denied. Sometimes, the process might have stalled within the insurance company, but no one bothered to tell me. Thus, if I didn't set a calendar reminder to call the insurance company two weeks after my submission, I could be sitting and waiting until the end of time.

Now, years later, I'm not sure all of that effort was really worth my trouble. All the paperwork, making copies of everything, filling out all the forms, dealing with the envelopes, the extra postage, the calendar reminders to go back into my files and refresh my memory of the outstanding issue before calling the insurance company to ask for an update, the denials, making copies of everything again to submit again, etc.

As I alluded at the outset, insurance absolutely can be helpful. If given the choice of having it or not, I'd have it. (Currently, I'm unemployed and uninsured.) But, I'd much prefer being financially independent and have the ability to see any provider of my choosing and get whatever test or procedure I desire. Insurance companies are, after all, businesses that exist to make a profit. I'd prefer they not impede my ability to get the care I need.

Though I don't have private insurance, I am able to get some "care" (using that term loosely) through the Veterans Administration. After seeing how they conduct themselves, I'd imagine this is what it's like to be on Medicare or Medicaid in the U.S. If so, then I see why the poorest among us have the worst health outcomes.

Lastly, the fact that any of us -- regardless of race, gender, or country -- has to suffer with our health is unforgivable, as there are enough resources available on this planet. I'd say the same for food, water, and shelter. As a species, humans do a lot of good things. But, we also have a lot of priorities wrong.

I shelled out $1375 for my first llmd/np visit. All it got me was an expensive tetracycline prescription ($160. It had recently dropped from $600. Can be had online for $20) which brought herx so serious I could not continue. She then wanted me back in for a follow-up, at $550. But in the mean I had tapped into Buhner, and after a bit of prayerful consideration, I concluded that this kind of money would buy a lot of herbs. I have taken a lot of self-inflicted wounds in my self-care, but I am certain the doctors would have done no better.

The medical system is such that it takes courage for a doctor to buck the narrative. By means of the Internet, I have enjoyed the knowledge of a few talented and courageous doctors, and herbalists like Buhner, and I feel I am way ahead of the game, considering I had undiagnosed TBIs for decades. I am indeed Blessed beyond the telling.

I just learned the other day that a mechanic I've known for a long time is in the hospital with Lyme, which he's had for six years. I haven't seen him in that long and didn't know he had it. The hospital is the last place I want to be, and that could have been me - it would have been me, had I chosen a different path; that is, if I were still alive at all.