just venting~seeking advice

Hi All~

I am feeling the need to vent. My HMO is now refusing to pay for my antibiotics. Imagine that!!!!!

Also, I have been feeling somewhat ok but the last few days, very tired but it doesn't last all day.

I'm on that gluten, sugar free diet. I feel like I'm starving being on it.

Do any of you have bouts of fatigue that seem to come from no where???

[JackieCalifornia]

Denying coverage is how HMOs (and all insurance companies) control costs...you can appeal, I think.  Look at the HMO's website to see what the procedures are.

I am on a diet with no sugar and no grains, and the first two days were awful -- because my blood pressure was tanking.  I felt very faint until my body realized it wasn't going to get a cookie no matter what, and then it shut up and got with the program.  Your body DOES think it's starving, as you say.  

If you have a yeast infection (even a small one), how you are feeling might also be a reaction to the yeast throwing a hissy fit because it's not getting its usual sugar to snack on.  The yeast thing was huge for me, and the die off was like a big Herx.  But after a few days, I was much better.

All of that felt a bit like fatigue, but it was especially strong those first days off sugar.  Because my blood pressure was so low (80s/50s), I had to make sure to use salt on my food to keep the BP up and not pass out.

One thing I have learned is to be SURE to eat regularly, even smaller meals more often, because there's no candy bar to give me an energy boost ... it all has to come from regular food.

Also keep your fluids up, and try to cook from scratch rather than use packaged or prepared foods, because those have tons of additives and sugars and garbage in them (just read the labels, they will tell you).  I know I sound like a health food nut, but I'm not!  I'm just a Lymie ....  and I feel so much better without the sugar in my diet (and trust me, I never met a Mounds bar I didn't love).

Hope you feel better soon.

[skarey]

I've came to the conclusion I have a yeast issue.  My mouth is killing me.  I now have white on the very back of tongue and my tounge is kinda whitish and furred.  I need to get in and see my dr.   The white on the back is new.  My tongue was just very sore and felt burnt.  My taste buds are very red and inflamed on the tip, and the sides of my tongue look wavy.  I guess I just assumed it was from the lyme espcially since I had the burnt feeling before beginning abx.    But I think it'll do me good to try to start eating healthier.  

What do you eat?  I'm going to have a really hard time cause I do crave my sweets.  Please any ideas or good websites on sugarfree diets would be appreciated.

Thanks!

[JackieCalifornia]

Yeast infections are probably not uncommon, based on what I've been reading ... after repeated rounds of antibiotics over the years, and just exposure to things like yeast in bread dough, we all have some yeast living with us.  Normally no big deal, but when things get out of balance, well, then it's a big deal.

I am a sugar junkie, always have been.  But now that I am off sugar, I don't really miss it very much.  Yes, an entire bag of cookies sounds splendid when I think about it, but not worth the results.  I'm much better off without.  At least for now, ha.

Call your MD's office and get an appointment and tell them what for.  They might even call in a prescription for you.

In the meantime, you want to shift over to a diet with as few things that would encourage the Lyme as you can.  Google 'anti-yeast diet' or something like that and you will get plenty of hits.  Good luck!

[kailau]

Hi,
I know how frustrating Insurance companies can be.  I work for a therapist office, a huge part of my job is fighting with insurance companies to cover treatment for kids with autism and other special needs.  Who is your insurance company?  Depending on your company and plan type, I may be able to give you some advice on what we've had success with at work if it's one of the companies I'm used to.  Usually with insurance companies, if you are persistent enough, you'll win.  Insurance companies count on patients giving up...don't give up!  Let me know if I can help, and I hope you feel better!
-Kai

[jkv44]

Hi,
thanks for the kind words. My insurance company is an HMO. Any advice?

[kailau]

It really depends on the company, each of their policies are different.  Usually HMO vs. PPO has little to do with prescriptions, it has more to do with in-network issues.  You may also have a secondary insurance policy for prescription drugs, which is very common (I have United HealthCare, but my prescriptions go through ExpressScripts).  A lot of insurance policies will farm out things like prescriptions and mental health benefits to second companies.  If this is the case, it can complicate things.  You may have a company like ExpressScripts, Walgreens Health Initiatives, or CVS Caremark.  If that is the case, try going directly to the prescription plan.  If you're not sure, call your Insurance company and ask them if they handle your Rx claims or if there is a secondary company.  You'll probably at one point have received a separate Rx card if you have a secondary plan.

Either way, step 1 is finding out who is the payer for Rx claims.  Step 2 would be finding out why the claim would be denied.  Is the drug not covered?  Do they cover name brands?  Generics only?  This is what you'll want to find out.  Also, a lot of times you can appeal.  They'll likely want a letter from your doctor stating that the particular antibiotic your doctor prescribed is "medically necessary".  That's a key phrase they look for.  Save copies of everything!  My hunch is the particular drug prescribed isn't a "preferred" drug.  Preferred or not, it's what your doc wants you to be on, so don't settle for any less.  You may be able to look into private pay options with coupons and such too.  Also, if you personally file a claim after your pay out of pocket, you may be able to get partial reimbursement.  

Good luck and I hope this info helps!  Like I said, it all depends on which company you have and how their claim process is.  Persistence is half the game, so just keep on them!
-Kai