Insurance Coverage in Pennsylvania for Lyme Treatment

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sierraDon
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Date Joined Aug 2016
Total Posts : 275
   Posted 1/18/2018 8:01 AM (GMT -6)   
Hello everyone, i was hoping some people could comment on insurance coverage in PA, as i just started treatment with an LLMD.

I was curious if i can expect my claims to be denied for my LLMD visits, oral antibiotics, and disability insurance claim.

I have Blue Cross/Keystone Health Plan East and live in Pennsylvania.

I have read in another post from some one that their oral antibiotics were covered, i was curious about the other items as well. I current submitted my first LLMD invoice to my insurance for reimbursement using their Out of Network reimbursement form, but didn't hear back (its been a week and half.)

thanks in advance

physedgirl09
Regular Member


Date Joined May 2017
Total Posts : 434
   Posted 1/18/2018 8:22 AM (GMT -6)   
Hi!

well i live in NJ and i see a Dr. Here. My Antibiotics are fully covered by my insurance. My office visits i pay out of pocket and I submit my claims every month. I have been reimbursed fully since i started treatment in June. So i only pay my copay for my prescriptions. Most people aren't so lucky tho. (i have horizon direct access)
A week and a half isn't long enough to know yet...my insurance company does take a while (few weeks, sometimes a month) to process everything and then another week to receive my check. So hang in there

sierraDon
Regular Member


Date Joined Aug 2016
Total Posts : 275
   Posted 1/18/2018 8:51 AM (GMT -6)   
Thanks so much for your comment, thats good to know that you get coverage in NJ.

Hoping some others chime in from PA.

Missouri
Regular Member


Date Joined Sep 2017
Total Posts : 394
   Posted 1/18/2018 10:05 AM (GMT -6)   
I have Blue Cross Blue Shield insurance. They did not cover my LLMD appointment. For meds they have covered a few of the hormone therapies, but only covered the first month of oral abx. So far for me, insurance has only covered a couple hundred dollars.

sierraDon
Regular Member


Date Joined Aug 2016
Total Posts : 275
   Posted 1/18/2018 12:37 PM (GMT -6)   
OK thanks Missouri. i wonder if its different with Blue Cross / Keystone Health Plan East. I read in a previous post that someone said they covered their antibiotics. I guess I will find out next month.

I just hope my disability insurance is not denied while I am out getting treatment.

Missouri
Regular Member


Date Joined Sep 2017
Total Posts : 394
   Posted 1/18/2018 1:13 PM (GMT -6)   
I hope it is better for you. Maybe it would have been better if I had a positive test. My test was 1 band short of CDC positive. rrrrrrrghhh

sierraDon
Regular Member


Date Joined Aug 2016
Total Posts : 275
   Posted 1/18/2018 4:36 PM (GMT -6)   
Thanks, yeah I am not sure. I have Igenex positive, but not CDC positive. I do have a repeat test coming back from MD Labs (from Hamilton, NJ) on Monday, curious what they will be.

I am more concerned about the Disability Insurance at this point, I am the breadwinner of the house. My wife is a stay at home mom, with our son and now taking care of me too.

I was thinking I wonder if Disability Insurance could be out for both Lyme treatment, and Mental Health related to Depression/Anxiety from the lyme. I have been seeing a therapist for years, on the mental issues around diagnosing this lyme. I dont see how they could deny the claim, as mental health should be a valid diagnosis for claim.

sierraDon
Regular Member


Date Joined Aug 2016
Total Posts : 275
   Posted 1/18/2018 4:56 PM (GMT -6)   
Looks like that is the ticket, need some vague diagnosis like fatigue and/or mental health
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