An acquantance of mine called me recently upset that her health insurance company was denying approval for her to receive more then 4 weeks of intravenous antibiotic for Chronic Lyme Disease. She had finally, after 6 years!!!, been diagnosed with Lyme. Bare in mind, this lady went from being a mid-30's, very athletic professional, to being wheelchair bound in the matter of 4 years. I don't know about you but it's still astonishing that doctors actually questioned whether there was really anything wrong with her because tests seemed "fine". Even her 3 year old daughter knew there was something wrong when she told her "Go doctor mommy. Doctor fix you".
Back on track......I asked her to forward me her insurance policy so I could read the small print.
Policy states:
"Insurance Company" will reimburse for the use of intravenous ceftriaxone, cefotaxime, or penicillin
G (for up to four weeks) for the treatment of chronic or recurrent Lyme disease.
Prior authorization is required for outpatient, office-based, and home infusion
services provided to members enrolled in our HMO, POS, and PPO products.
"Insurance Company" does not reimburse for the use of parenteral antibiotics
beyond four weeks, as there is no evidence indicating that such use is
beneficial in the treatment of chronic or recurrent Lyme disease. We also do not
reimburse for parenteral (IV or IM) imipenem-cilastatin, ceftazidime,
cefuroxime, vancomycin, bicillin, or ampicillin for the treatment of early or
late disseminated stages of Lyme disease, as there is no proven role for the use
of these agents. It is recommended that use of these antibiotics be avoided,
too, as prolonged use may encourage community-based resistance.
I have changed the name to "Insurance Company" as my battle is not again this particular company but all health insurance companies I have come across. It's their overall lack of knowledge. Their amazing ability to deny the existance of an epidemic that is effecting millions of people around the globe. How is it that our government can spend billions of dollars on swine flu vaccinations (almost half which have expired and were never used) yet this epidemic of lyme is being overlooked?
How is it that people are paying tens of thousands of dollars a year, out of pocket, in order to receive the treatment they NEED in order to save their lives?
MANY people are SUFFERING from Lyme. MANY people are FINANCIALLY DEVASTATED from Lyme. MANY people have become DEBILATED from lyme. MANY people have DIED from Lyme.........
MANY PEOPLE JOINING TOGETHER CAN MAKE A CHANGE AND HELP DEFEAT LYME.......PAY IT FORWARD!
I can't believe how awful the insurance companies are. I have also written a blog about this same topic. I wanted to share my story with you as well. I know this story is about me, but it is very similar to what many other Lymies experience as well and I think it really tells many of our stories.
ReplyDeletehttp://twist-of-lyme.blogspot.com/2012/12/everything-i-havent-told-youincluding.html
Also, here is a great explanation for why things are the way they are for us. Brittany did an amazing job researching and learning about this after her own battle with Lyme. Now she is much healthier and she is not staying quiet! I love it! She was featured on Monsters Inside of Me and has used that to spread a big message.
http://twist-of-lyme.blogspot.com/2012/12/great-explanation-of-lyme-disease.html
Also, I hope it's okay to add a link to this blog post on my blog. I love what you wrote in so few words! :)
Hi Elizabeth and thanks so much for your comment. It's so important for all us to get the message out there. Particularly us who were blessed enough to get well and have the energy to do so. I would be honored to be noted on your blog and I will happily add a link to yours as well :)
DeleteOh looks wearied.I just want to know that How can it be legal for a Medical Insurance Company to deny benefits to a customer?Isn't that the whole reason for paying for insurance? Shouldn't all conditions, ailments, and injuries be covered? If not, then way are we paying into insurance.
ReplyDeleteI totally agree with you! I've seen both healthcare systems up close and personal.
ReplyDeleteIn England I worked for a division of the National Health System. There, all people have insurance which covers all medical needs (minus dental). Sounds like an ideal world but this open access also created a SEVERE shortage of staff leaving many patients requiring immediate surgery or treatment (we're talking life of death situations) on 2+ year waiting lists. Then we have the flip side....the USA and private insurance where each companies has the power to approve or deny the majority of our care. Someone behind a desk, with no true medical training, is deciding whether we get the test/treatment we need. Shouldn't this be determined by our physician/specialist who's recommending such things. I guess we need to find a happy medium....a balance between the two extremes. What that is....I have absolutely no idea.......