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Justify Lyme Treatment to Health Insurance Company?????

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Old 10-09-2008, 09:52 AM   #1
Join Date: Apr 2007
Location: Maryland
Posts: 3
Faithful1 HB User
Justify Lyme Treatment to Health Insurance Company?????

Life's been crazy for the past 2 years. Long story short, I know I have Lyme Disease and so does my doctor. The problem is that my tests don't result in a completely positive reading. The first blood test showed one band positive and two undetermined. The next blood test showed a different band positive than the last and two undetermined. I'm really scared because I've had it for some time and I read about what happens when it enters your brain. Many of these things have already been going on with me for several years, but I just thought I was a depressed person or something. I also know I have Lyme because 3 weeks ago my doctor started me on strong antibiotics and I experienced the most horrible symptoms of my life. I didn't know what was going on until I learned about Herx. Still, it seems my doctor can't justify an MRI, spinal tap, or even intraveinous antibiotics until my blood test shows at least 2 positive bands. My doctor tells me that he has found that after a lyme patient is on antibiotics, a lot of times the next blood test usually shows up positive. I don't understand the insurance company. I'm scared to wait another day. One of the many symptoms of lyme that caught my attention was "unexplainable hearing loss". I had a severe hearing loss when I was in 2nd grade that no medical professional could figure out. I couldn't even finish school. Then, in 5th grade it happened to me again. Today, I am 44-years-old and I can hear just fine. I had a tick on the back of my neck when I was about 4 or 5-years-old. Lyme Disease hadn't been discovered back then. All of these years I've felt like I've been so difficult to live with. I'm a very motherly and nurturing person. I'm nearing the end of raising 6 daughters. My husband and I did foster care and adopted and we have great kids. But, sometimes something would suddenly set me off on what seems to be a fit of rage. The weird part is that I never feel angry during those times. What I feel is extremely frustrated. I never knew much about lyme. I didn't know it could get so bad. Right now I spend a good amount of time in bed feeling guilty because I feel like I'm neglecting my family, but I'm too fatigued to do anything about it. Since I've been experiencnig these extreme symptoms for about 2 years, and since I've learned that the symptoms of lyme can be set off by chronic stress, I figure it all started when my mother came to live with me so I could care for her until she died. She had severe COPD and had only been given a week to live. She came to live with me on March 3, 2006 and she passed away on December 26, 2007. I never went to the doctor for my symptoms during that time because I thought they were a result of the overwhelming stress I was under. Anyway, has anyone experienced my particular health insurance problem? Since many people who have Lyme test negative, I'm hoping there is a way to justify treatment for it with the health insurance company.

Last edited by Faithful1; 10-09-2008 at 09:55 AM. Reason: Email Notification

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Old 10-09-2008, 08:38 PM   #2
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Join Date: Oct 2007
Location: new york, ny, united states
Posts: 119
ktinbk HB User
Re: Justify Lyme Treatment to Health Insurance Company?????

Hi Faithful1,

I'm sorry to hear you've been struggling with lyme for so long and that you've had such a hard time getting started on treatment. i had lyme for at least 10 years before we figured out what it was. unfortunately i had to see a doc outside of my insurance plan to get a diagnosis and treatment. but it's been well worth it!

did you get your lyme test done by a local lab or by Igenex labs in Palo Alto, CA? i ask b/c a lot of people have a hard time getting a positive even when they know they have it (in fact, blood tests are not 100% accurate and lyme should always be a clinical diagnosis and not one based on tests). Igenex is the most accurate Lyme lab and you may have more success getting a positive that way.

also, are you seeing a Lyme Literate Doctor? they would probably start you on oral abx in the meantime if your insurance doesn't cover IV. a lot of us aren't able to get our treatment covered by insurance, and it can be very tough but a good doctor can probably help you find a way around. my insurance covers my antibiotics, MRIs, etc, but not my visits to my LLMD. i see specialists for the tests and they have been able to get this covered by prescribing the tests for individual symptoms ("severe headaches", etc). i don't know about the intravenous abx though. i have been on orals for 10 months and my insurance has covered those (knock on wood that this continues).

there are probably people here who can offer better advice with this. so far i've just charged those expenses that are out of my reach. do you have an open access plan that allows you to see specialists or do you need a referral? i wish insurance companies were more educated on lyme disease. unfortunately, i think there is a long way to go in that area. but you should definitely not let that keep you from getting treatment.

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