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Does insurance cover medications and tests?

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Lyme Disease
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Posted 2/27/2016 2:56 AM (GMT 0)
I'm really concerned that once I find a llmd that insurance won't cover it . What experience has other people had? I have great insurance with the company I work for.

Thanks in advance
Posted 2/27/2016 3:08 AM (GMT 0)
When you get recommendations - you can call the office and ask if they take your insurance.
I don't live in the U.S., but from what I've seen on here...many don't take insurance, unfortunately.
Posted 2/27/2016 3:25 AM (GMT 0)
If you have out-of-network coverage, you might be able to get reimbursed I don't know the level of reimbursement but I know people have been able to get money back.

Same deal with testing and meds. I'm sure each insurance policy has specifics and it might not be a bad idea to see just what might be covered.

The good news is that the ILADS guidelines are the only Lyme guidelines on the National Guideline Clearinghouse right now. I think that will make it harder for insurance companies to deny treatment.
Posted 2/27/2016 3:26 AM (GMT 0)
Most LLMD/ND's don't take insurance. It's really a case of insurance companies not taking Lyme doctors.

It really depends on your insurance. You can submit your receipts as out of network claims and hopefully you will get reimbursed at the out of network rate. Prescriptions should be covered and all your standard blood work should also be covered. You can also submit your Lyme tests if you get tested by Igenex.

Many of the common Lyme and coinfection prescriptions are what's deemed non formulary. Depending on your health insurance they will either tell your pharmacy that the rx needs pre authorization from your LLMD or that the rx has been denied. I also have excellent insurance but the way my insurance handles non formulary rx's is to tell my pharmacy that the rx has been denied. My pharmacy has it in their computers that if an rx of mine gets denied that means to fax a request to my LLND for a pre authorization.

I deal with our companies insurance broker. On the first denial my broker was all over the insurance company. They quickly explained that the rx wasn't really denied. They just needed more info.

If you have a positive test it will make getting the expensive meds covered easier. Best of luck.
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