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Old 08-20-2006, 07:08 PM   #1
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Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

If you have been back, please give us an update so we may know what to expect. Prayers....Marsha

 
Old 08-24-2006, 06:25 PM   #2
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

I'm a Jemsek patient, too, and anxiously awaiting a report from another patient. With 1000 patients you would think someone would be on the board with a report. I check this post everyday to see if someone has posted.

 
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Old 08-24-2006, 08:24 PM   #3
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

I do go back in two weeks. Maybe I'll know then. I'm a little upset with the clinic and BCBC of NC. At my first visit in early Jan, I ask and was told there would be no problems with my insurance. Then several months later I was told that They knew BCBC of NC had requested all lyme files and were looking back to see when treatment began and how far into treatment I was. Yet I was not informed by anyone of the probable problem unil April.

I just received a notice from quest lab when nothing was paid and a bill from Jemsek Clinic that totals over 5,000. What is a person to do. Money is tight. I would have switched over to orals earlier had I know insurance was going to deny payment. What rights do I have to fight this. I will appeal with the insurance co. Also I was told that there is a class action suite with many of the patients filing against BCBC of NC for what this has done to us. Anyone familiar with this.

Anyone going to Jemsek, please let us know what you find out.
Prayers.....Marsha

 
Old 08-25-2006, 04:15 AM   #4
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

I was a patient at Jemsek clinic in 2004-2005. I had no problems with them or my insurance. I'm not sure what is meant by "the conditions were set"- can someone explain please?

 
Old 08-25-2006, 04:45 AM   #5
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

Marsha,

I would definately go talk to a lawyer and see what he thinks. It is too much money and too many legalities to try and figure out what to do. Sometimes just a letter from a lawyer is all that is needed for a doctor or insurance company to back down. The insurance companies are like bullies that need someone to put them in their place.

 
Old 08-25-2006, 11:41 AM   #6
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

Hi Marsha

Sorry to hear about your troubles with the ins co. Having lyme is stressful enough without adding ins troubles to the mix.

As far as your Dr billing you, I don't think they can if they were an in network provider at the time of service. I know you don't want to get into a conflict with them, as you need their care, but that is alot of money.

My neuro (who is in network) just billed me for a test done in 2004 that was $1,100. that my ins has not paid for and has been giving them the run around on. I feel bad for them having to deal with the ins and the hard time they give the Drs. The Dr sent me a notice that they were going to send this bill to collections. I have spoke to them many times on this so it is not a case of me just ignoring it. When I said to the billing person I am not responsible for this as you are an in network provider, she said your right. The in network provider has a contract with the ins co. The bill is between the Dr and the ins co. Services provided after your Dr was out of network is another story.

I hope you can straighten this out soon. Lynnp is right sometimes a letter from a lawyer will get someone's attention.

Hope you are feeling better these days.

Kim

 
Old 08-25-2006, 07:25 PM   #7
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

Thanks guys.
Dynawg - Dr Jemsek had to go before the medical board because of charges against him. The conditions were set by the medical board. This just happened earlier this summer.

Lynnp - and Kim - this is taking an expected turn. I didn't consider the in-network. My insurance only notified me about a month ago that he would no longer be in - network. I had paid my co-pay each time I went. In April when Jemsek Clinic offered to handle my appeal they told me they would send me copies of all they did. I did not receive any copies. In January when I changed from BCBS Il to BCBS NC, I ask if there would be any problems with the change in insurance. They told me no. I was not informed by either Jemsek Clinic when they knew they were being investigated in January or my Insurance Co when they started the investigation. I was only told months later when the decision had been made. I had been prepared to pay, but now I think why should I. Who is wrong here? I did receive the treatment but would not have continued on IVs if I had known. I'm not sure how they are coming up with the amount they are because even my insurance last year was 80/20 with a out of pocket max. This year is only a co-pay.

I do feel that I need to continue treatment, and maybe that is what they are hoping. But at this point, I have enough antibotics to continue for a couple months. And I think I have learned from this board, there are other ways to treat lyme. I go back week after next. I think I need to prepare. Think I will first have to talk to the Drs office. Also have some lab bills that I am unsure of as well. Wouldn't the same apply to them?

Thanks for the input. It is hard to think straight, between the augmentin and the flagyl this week, my brain took a vacation.
Prayers and I hope you are showing improvement.
Marsha

 
Old 08-28-2006, 07:47 PM   #8
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

I, too, am considering a natural protocol for my treatment plan. We will have to keep each other posted as to the turn of events at Jemsek. I wish you the best at your next appointment. Pray for wisdom and favor before you go.

 
Old 08-28-2006, 08:37 PM   #9
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

I am most likely wrong...and can't remember where I read about him...but seems like I read he can only treat people for 3 weeks on antibiotics....

like I said I am most likely wrong............what a crappy thing to happen to a doctor that is trying to help....really a shame!!!!

Hugs..........

 
Old 08-29-2006, 12:00 PM   #10
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

Did find out today that as of next month, (sept) they will not accept insurance. They are changing from the now out of network to not accepting insurance at all. Dr Jemsek actually called me about his water garden today. Wants me to bring him fish and we can barter the fish for the visit. He didn't mention the bill, and I didn't. I will take that up with his insurance dept next week. This will likely be my last visit with him. I can not afford to continue and pay what I know it will be. Not just his visit but lab and meds I don't think will be covered. Not sure about that. (maybe someone knows the answer to that) I will pray for wisdom and guidance and I appreciate your prayers. Oh I am so tired of this battle.
Prayers...Marsha

 
Old 08-29-2006, 12:32 PM   #11
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

Hi Marsha

I too am considering adding more natural products to my protocol. I am wondering if the amonia is what has been affecting my dizziness and balance. It has gotten to the point where I can't even walk across the room without holding onto walls and furniture. I am going to look at Jernigans formulas to see if maybe that would help. Need to hit this so very persistant bacteria from many angles.

These insurance co count on sick people to not protest and that is how they get away with alot. I find almost every bill requires a call to them. I went for PT and the first EOB came with o paid and "benefit maximum used for the year". I get 30 PT visits a year and had not used even 1. A call was required and they have periodically used that throughout the billing. The first time cleared up and 5 visits later they pay $0 and use the "exceeded max benefit # visits".... again. Luckily my PT who is out of network, agreed to take my co-pays only as if I am in network are following up and dealing with the ins on this. Very nice of them as they don't have to have the headache as they are out of network.

I think that if your Dr was in network until you were notified otherwise then your payment should be just as it was, and they can't go retroactive. Usually the ins co or Dr will notify you that as of a certain date in the future this Dr will no longer be in network. They can't notify you after the fact and expect you to pay for back visits. Either the Dr or Ins should have notified you of this and it is their mistake and should not be your problem. Like you said you may have chosen treatment differently if you knew about costs you would have incurred.

The ins co use the excuse that even if they authorize something that does not guarantee payment, and I think you can fight that too. I had an MRI that they authorized, gave an approval #, and then decided they didn't want to pay. The bill was $2,000. Had to call and write a letter but straightened it out. I pay for my own ins as we are self employed and it costs us $1,400 a month. I am not going to let them get away with anything. It creates stress
I know and hard to find the engery sometimes.

Didn't mean to go on a rant but the headache with ins co gets to me. I hope you can deal with them and don't get stuck with a big bill.

I think I have read you are doing better and am glad to hear that!

Kim

 
Old 08-29-2006, 05:37 PM   #12
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

Thanks Kim
I could sit down and cry from the fatigue and stress of it all. But this is a battle I have to face. I do believe that both the Dr and the insurance should have informed me and that they can't go back to the first of the year when I wasn't informed until months later. If I have to see a lawyer I will, but first I will call the insurance co and discuss it with my dr.

Sounds like you are having a very rough time. I was thinking today, is it the ammonia or the lyme that is the problem. I don't know. By the way, when did you actually begin treatment? Have you seen any improvement? I noticed you came to the boards about the same time I did. Has your stricker panel improved? That is one of the test the Dr never did on me. Do you remember how much it cost for this?.

I am to go back Tues to the Clinic, but I have already decided to detox as much as possible and do without meds for as long as I can. I am seriously considering Dr J detox formula. Let me know what you decide.

Hope and pray you can get your dizziness and balance back under control.

Prayers....Marsha

Last edited by Pearlscale; 08-29-2006 at 05:45 PM.

 
Old 09-01-2006, 07:31 AM   #13
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Exclamation Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.

I talked to the Jemsek Clinic today and they confirmed what you said. As of Oct. 1 they will not be accepting any insurance for Lyme Patients. I will definately have to find another doctor now. The only reason I flew from NJ to NC was because my visit was $10.00 and my tests were covered 100%.

With this new development, the choice has been made for me. I am either going to have to find a LLMD in my area and pay out the nose for medical bills, or go the natural route (and probably pay out the nose for natural remedies).

I am still really surprised with all the Jemsek patients out there from 48 states that more people haven't responded to this post.

 
Old 09-06-2006, 10:14 AM   #14
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Re: Anyone Been Back To Jemsek Clinic Since The Conditions Were Set.



I go this coming Tues. I will let you know what they tell me. A friend went last week and he said they gave Dr Joe a 60 day stay until they work out the details. I would rather give you an update from my visit though. There is a press release on his wesite as well.
[url]http://www.jemsekclinic.com/files/PressRelease_NCMB.pdf[/url]

 
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