Guest guest Posted May 24, 1995 Report Share Posted May 24, 1995 hi joan they tried to cut me off after i told them that i would not sue my doctor for trying to help me cause i am so sick. that i would hold them totally respaonsible for my health, my dealth , my life that i would sue them for refusing the care that i sooooooo needed was not even 5 minutes i got a call back stating that they will contiue with the iv therapy with a week by week approval until the appeal is complete be firm and brassy let them have it!!!!!!!!!!!!!!!!!!!!!!!!!!! love cindy in mich Re: [Lyme-aid] Ins. ? > Has anyone been successful in fighting insurance coverage denials > considered " Not Medically Necessary " ? > > Thanks, > Joan LI NY > > > > > > ------------------------------------------------------------------------ > Sign up for the free zZounds.com newsletter for the latest and > greatest music gear savings, musician tips and hot contests. > 1/3738/8/_/484634/_/959118342/ > ------------------------------------------------------------------------ > > is dedicated to Marta McCoy, the foundation behind what is today. > > Easy Reference: > Send a blank email message to: > > -Subscribeegroups - Subscribe to the list through email > -Unsubscribeegroups - Unsubscribe from the list > -Digestegroups - Switch your subscription to a digest format > -Normalegroups - Switch your subscription to normal > > Please send messages not related to Lyme disease to -Offtopicegroups > > Archives can be accessed at lyme-aid > > Please visit the chat room at chat/lyme-aid > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2000 Report Share Posted May 23, 2000 Yes, you just do not give up the fight. You escalate through each level. In the meantime, pursue your state insurance commission with complaints. You present information concisely, condensed and simply. Don't beat around the bush. Sincerely, Annie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2000 Report Share Posted May 23, 2000 Has anyone been successful in fighting insurance coverage denials considered " Not Medically Necessary " ? Thanks, Joan LI NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2000 Report Share Posted May 23, 2000 Joan, only one time did my insurance try to say that to me. I talked to 1 adjuster that was great, we kicked up a 'comraderie' so i always asked for her. I sent her some info, of course stating my point of view, and she accepted it. Got approved and havent had any other probs. Pepi > Has anyone been successful in fighting insurance coverage denials > considered " Not Medically Necessary " ? > > Thanks, > Joan LI NY > > > > > > ------------------------------------------------------------------------ > Sign up for the free zZounds.com newsletter for the latest and > greatest music gear savings, musician tips and hot contests. > 1/3738/8/_/484634/_/959118342/ > ------------------------------------------------------------------------ > > is dedicated to Marta McCoy, the foundation behind what is today. > > Easy Reference: > Send a blank email message to: > > -Subscribeegroups - Subscribe to the list through email > -Unsubscribeegroups - Unsubscribe from the list > -Digestegroups - Switch your subscription to a digest format > -Normalegroups - Switch your subscription to normal > > Please send messages not related to Lyme disease to -Offtopicegroups > > Archives can be accessed at lyme-aid > > Please visit the chat room at chat/lyme-aid > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 documantion and studies help.......save the ny times articl on steere...it disproves what the ins. co. say...also the star ledger article shows how many conflicts of interest " their side " has......it isall good for fighting.....i knwo i have been there.....we are fighting for our lifes when we have no quality of life.....strange huh.......????? Reid....... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Dear Joan, I have Oxford, too, and I wasn't successful. I went through the Health Care Dept. of the NY Atty General and the DOH of NY, and they can't do anything (so they say). The DOH even agreed with Oxford that I didn't need further treatment. They won't pay for the Babesiosis treatment, either (I was on IV Zithro along with oral Mepron. They paid for the Mepron). Eileen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Thanks Annie. I will not give up the fight to have IV ABX approved. It is so frustrating, and makes me so angry, but fight I must. You know, it's amazing to me that Oxford would pay multiple of thousands of $$$ for testing, looking for a different dx other than LD. I was told that if I had a joint infection, that IV ABX would be covered. It's a sick world... Take care, Joan LI NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Hi , They make everything so difficult for us...stress that we don't need, and makes us sicker in the end... Feel better, Joan LI NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Hi Eileen, Something has to be done about this...the NY DOH is becoming a real problem. Aren't they the ones who decided that NY MDs can no longer use IGeneX for LUATS and Babesia PCR's? Take care, Joan LI NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Hi Again, , I wonder if a call from my attorney would help? At this point, that's all I can think of...my LLMD has done all he can to have me approved. Feel better, Joan LI NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 In a message dated 5/24/00 3:03:39 PM Eastern Daylight Time, Namkrats3@... writes: << I wonder if a call from my attorney would help? At this point, that's all I can think of...my LLMD has done all he can to have me approved. Feel better, Joan LI NY >> why dont you have his office send out a letter...or do what my lawyer friend advised...formulate a good letter based on the points they raise...and on the bottom...make sure you put cc: (laywers names) this way they know you are not going to back down...and it can be a first step YOU can do...and save a few dollars...b Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Dear Eileen: If they pay for Mepron, they have to pay for Zithromax. One cannot take Mepron without Zithromax due developing a resistance. Did you present it this way? Sincerely, Annie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 Dear Joan, I didn't know that the DOH decided to disqualify IGenex's Babesia test. If so, that's why they totally ignored my diagnosis of Babesiosis. They just sent the drivel from Oxford and Oxford's hired gun, Halperin, to me as reason why they feel Oxford was right. Eileen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2000 Report Share Posted May 25, 2000 Dear Annie, The prescription plan covered the Mepron, but you need formal pre-authorization for intravenous antibiotics. I wasn't going to wait 8 months (like I did for my 30 days of IV Primaxin) to get started. Their contention is that I should have been treated with clindamycin and quinine, and I wanted Zithromax for my Lyme disease that I don't really have because their consultant said I don't have it. They're a--h----! And the NYS Attorney General's office couldn't/wouldn't help me. Eileen Quote Link to comment Share on other sites More sharing options...
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