lymeoutlyndsey

My journey through Lyme Disease- Healing my body and mind.

What about insurance?

For the best explanation of why insurance does not cover the long-term treatment of Late-Stage Lyme Disease, please find the time to watch the following documentary:

http://www.underourskin.com/

It is available for viewing for free on hulu.com

For those of you that won’t make the time to watch the above documentary, I will attempt to explain the Lyme insurance debacle below (though you really should watch the documentary).

Lyme Disease research is just recently approaching the idea that some people who are infected continue to show signs of illness for long after they are treated with antibiotics after their initial tick bite. Gradually, the medical community is coming around to seeing that Late-Stage Lyme is a real problem and that we need to acknowledge and treat those patients. Currently, the Center for Disease Control (CDC) and my home-state’s department of health (Washington State Department of Health) both recognize Late-Stage Lyme, however, the Infectious Disease Society of America (IDSA) does not yet recognize Late-Stage Lyme. The IDSA writes treatment guidelines that physicians follow, and since they do not recognize Late-Stage Lyme Disease, their treatment protocol is 4 to 6 weeks of antibiotic therapy immediately following the initial tick bite. So, if you did not get treated immediately following the tick bite when you were infected, you are not addressed in the IDSA treatment guidelines. This conflict has given insurance companies a way out of treating Late-Stage Lyme patients who would potentially be taking antibiotics for years. Interesting, though, is the fact that insurance companies are okay with paying for long-term antibiotic treatment for things like acne.

Another complication with insurance is that finding a medical doctor that has any clue about how to treat Late-Stage Lyme Disease is difficult. The only doctor available to me for Lyme treatment is, of course, out of my preferred provider insurance network. My insurance is provided through my employer and my out-of-network benefits are: after I pay $8,000 out-of-pocket annually, they will then cover 50% of office visits and prescriptions. However, I filled out all of the proper claim forms and they returned all 18 of my claims sighting reasons that were outright LIES, like they needed a CPT code that was written TWICE on the forms. Of course, I am following up with all of this mess, but it is criminal the way insurance companies behave.

So, they cover half of office visits, but the majority of my cost comes from therapeutic doses of vitamins, minerals, probiotics, enzymes, and herbs, all of which are medically necessary, but for which insurance will not pay. Just as an example of the cost: If you take probiotics everyday (which you should), you probably take about 10 billion strands a day (one normal-dose probiotic pill). I take 200 billion strands of probiotics PER DAY to replace my healthy flora that I am killing with antibiotics. I spend approximately $375 per month on probiotics alone. Some insurance companies will pay for probiotics if you have your physician write a prescription for you. However, they will only pay for a “typical” amount- the 8 billion strands a day.

We need more Lyme Disease research and we need healthcare reform.


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