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Avatar universal

Do Lyme docs accept insurance?

I just saw a post down below that comments on whether Lyme doctors accept insurance.  The statement was that the docs do NOT accept insurance, but let me add something to that:

My Lyme doc did not accept insurance, because it requires a whole bunch of back office clerk etc. to do the billing and hassle with the insurance companies about how to treat and how long to treat Lyme disease.  The insurance companies may rely on 'old think' and say that a short course of doxycycline is all you get, when actually it may not be the right medication for the right length of time.

HOWEVER -- my Lyme doc would give me a bill and I would pay it, then I would submit a claim to my insurance company.  The insurance company then reimbursed me for a 'out of network' doc, which was a reasonable amount.  The insurance company also paid the regular rates for medication prescribed by my Lyme doc, no questions asked.

Why the silly dance?  Because the insurance companies don't want to be accused of assisting in treatment that is not approved by nonLyme docs.  There is a serious split in the medical community about how to diagnose and treat Lyme, and the ins. companies don't need the hassle.  

So when your potential Lyme doc says 'we don't take insurance', ask if it works for them to give you a bill from them, which you then you submit it yourself to your ins. company, and when you are reimbursed by your insurance, then you pay the doc.  That way the insurance companies are not 'supporting' the type of Lyme testing and treatments that so-called mainstream medicine supports.  That is how my Lyme doc approached the billing and payment, and it worked fine.

Ask the doc if that approach works for him/her.
1 Responses
Avatar universal
My Lyme doc is out of network for all insurances ("doesn't take insurance"), and yes, after I meet the out of network deductible, I do get about 40% of the cost back.  The dr's office will do the initial submission to the insurance company, but nothing more.

I have had more costly issues with (lack of) coverage for the prescriptions, because most of them have limits on the number of pills that the insurance will cover in a given period of time.  For example, azithromycin was covered for 6 pills every 28 days (and of course, "covered" means they will pay their part of it).  I needed 24 pills every 28 days, so I had to pay the full cost of the 18 that were over what the insurance company determined was sufficient.  And that was 1 of 4 drugs in my regimen.

Last visit my dr. prescribed a month of a relatively new drug (maybe 5 years old) to see if it helped (so, sort of an experiment, not a critical component).  It's only insurance-approved for 6 pills (3 days worth, which is 1 weeks dosage) every 25 days.  The drug turns out to be $50+ per pill so I am collecting 4 weeks worth one week at a time every 25 days.  I consider this a ridiculous necessity:  it's $22 for a week's worth with the insurance coverage, $317 without.  Fortunately this is a drug I can wait to try and not something I needed immediately, since $1300 out of pocket is absurd!


  
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