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06/15/2009 05:38 AM

Doctors that don't accept insurance

DDD
Posts: 10
Member

Hi everyone-

I am fairly new to this group and have really enjoyed your encouragement and replies. There is one area I could really use some input on - doctors that don't accept insurance. Are they genuine... or are they taking advantage of people that are in pain and desperate?

My husband is in the middle of a Lyme reoccurrence; we have an appt. with an infectious disease specialist in September. Based on everything I've read, a mainstream doc is going to be useless. But a recommended Lyme specialist in our area ) doesn't take insurance charges $450 for the initial visit and $150 for each subsequent visit. This sounds outrageous. I am willing to climb whatever mountain I have to in order to help my husband... but something about this way of doing things just seems wrong.

Any thoughts?

Post edited by: DDD, at: 06/29/2009 12:27 PM

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06/15/2009 06:05 AM
jaime1978
jaime1978  
Posts: 2399
VIP Member
I'm an Advocate

no they aren't frauds or taking advantage of people... one example is a well known doc who has a 90% sucess rate was taking ins. bcbs didn't like it, went after him and he lost his lisence, so he basically relocated and doesn't take ins anymore. the ins companies like to tell them how to treat and how not to. (ie no long term treatment) they go by the guidlines of max of 30 days of antibiotics, which isn't enough.

if you send me a pm I can get you a list, let me know your state and other states you can travel too, SOME do take ins because lyme isn't thier "main" practice, the only take a certain amount of lyme pts and fly under the radar.

you are right, mainstream docs are usually useless, mine for instance, even though I remember having two engorged ticks burned off my spine (worst thing you can do is burn them off) said oh no, chances of that are so slim, blah blah blah....most don't even remember the bite, or get the rash, and it's not just ticks, but fleas , mosquotos, dust mites, etc...


06/15/2009 08:04 AM
DDD
Posts: 10
Member

I live in Maryland and Dr.C was on a recommended list; someone wrote that she was highly recommended by Dr. S. I called her office and they said I have to write up a page describing his situation; then Dr. C would decide if he was someone she could help. I'll give it whirl.

Post edited by: toothfairy55, at: 06/15/2009 07:32 PM


06/15/2009 08:35 AM
shotzie
 
Posts: 55
Member

That price isn't that outrageous, they spend a lot of time with you and do not give up if treatment isn't working, they put thought into every patient's treatment plan, not just a one size fits all approach.

Some insurance companies will reimburse part of the cost, at least at first.

I worked in medical offices and know the influence that insurance companies put on physicians. In HMOs docs are questioned when they refer to specialists, sending anyone out of plan is frowned upon. Specific treatment guidelines are given for specific diseases.

There are recommended drug lists,use of those not on the list is discouraged. Generics are highly encouraged and we are now starting to find not all generics are created equally. People are sent into the offices from all the insurance companies to "review" records to make sure the physician is towing the line.

Lab tests that some LLMDs use are questioned, they fall outside "standard care guidelines".

Doctors in insurance plans are not encouraged to think for themselves. That is a very dangerous thing.

Post edited by: shotzie, at: 06/15/2009 08:36 AM


06/21/2009 03:25 PM
Zeke
Zeke  
Posts: 264
Member

I also work in the health field for a chiropractor...we actually still bill for patients...but that is a courtesy of our office.

So...it is a matter that your ins may cover services at that docs office ...the docs office just isn't going to do the billing...believe me, I also do the medical billing at our office and it is a big job. Alot of docs, especially private practice are getting away from medical billing.

The LLMD that I see doesn't bill either...but what they do give you when they give you your receipt is a paper with the services they provided checked off on the sheet; ex: office visit (with the E/M or CPT code that your insurance wants and the dxs code) So, it is up to the patient to submit their own insurance bills.

That way the patient ends up dealing with their insurance if services are not paid for etc...

Then it also depends on your policy...in-network, out of network, do you need a referral, etc...

So, if you found a doc you like, you may ask them if they provide you with the codes your ins. needs to submit your bill & find out exactly what is covered through your carrier.

Post edited by: Zeke, at: 06/21/2009 03:29 PM


06/22/2009 03:37 PM
MorningSong

DDD~

I tried the Infectious Disease route. There are 2 Infectious Disease clinics at 2 different hospitals in our area. I went there with positive blood tests (Western Blot). Both stated that the results were false positive, they would not treat me, and stated that I needed to find another cause for my symptoms. Maybe you will have better luck than I. I know Lyme Doctors are very expensive. There are some (a small amount) that actually do take insurance if you can find them. I saw on another website where someone found one. I know how hard it is financially. I wish you and your husband the best.


06/23/2009 03:13 PM
karazon
karazon  
Posts: 31
Member

I haven't been to any LLMDs yet that take insurance. At least my current doc accepts credit cards, others only want cash or check. The price you were given sounds similar to here in NJ, I pay $160 per visit.

There is a highly rated LLMD near me that charges $750 for the first visit! Hopefully your insurance will reimburse you for part of the cost.


06/23/2009 04:38 PM
lindaca
 
Posts: 1009
Member

Best advise is to check with a local lyme group to see if there are docs that others aren't aware of. I connected with a SoCal group, and they have provided me with resources that I would not have found otherwise. The lists that the lyme websites and the MDJ group leaders have are a great starting point, but they are incomplete since they are not updated regularly. My experience with the local lyme group is that you need to attend a meeting in order to get the best info - they are not comfortable with emailing doctor names/numbers. I was able to find a local LLMD (ID) who will help, and even though she's not one of the designated "experts", she seems to know what she's doing. Seems the biggest disadvantage to going to someone who doesn't have a practice focused on lyme is that they don't necessarily have the resources needed to fight your insurance company for treatment coverage. The advantage to someone local is that I can see her on shorter notice if something causes concern with limited wait time or travel time.

07/18/2009 06:59 PM
feellikecrud
Posts: 124
Member

I found one that would not take insurance, he wanted 750.00 for the first hr. then 450.00 for follow ups. Did not include any test or med.

07/18/2009 07:24 PM
toothfairy55
toothfairy55  
Posts: 3856
Senior Member

Sounds like alot of money. Our LLMD was 350 initial and about 130 for follow ups
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