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Lyme Disease Confusion Ensnares Sick Patients in Treatment, Insurance Complications

Antares in NYC

Senior Member
Messages
582
Location
USA
Heartbreaking and very real report about the nightmares of dealing with insurance coverage for Lyme. I'm sure many in these boards can relate to this.

Also note there's the mandatory quote from Dr. Wormser, always muddying the waters and defending his flawed methodology:

Lyme Disease Confusion Ensnares Sick Patients in Treatment, Insurance Complications

When Pope Francis touched down at Kennedy Airport, 12-year-old Julia Bruzzese was there to greet him. Sitting in her wheelchair, the pontiff put his hand on her forehead and blessed her.

“It means that he’s going to give me a miracle, to walk again,” the teen told NBC 4 New York afterward on Oct. 24, fighting back tears. “I know I will walk again because of him.”
And a miracle of sorts did happen, at least, in her opinion.

Dr. Ronald Stram in upstate Delmar, just outside Albany, was watching Julia and reached out to her family because he believed he could help. “It broke my heart,” said Stram. “I knew that she had a suspicious disease that had gone undiagnosed and I think that Lyme is a very complicated disease and it was one to at least explore.”

It was in June of this year that Julia, who was once vibrant and athletic, suddenly was unable to walk. A few specialists believed she had Lyme disease, but her blood tests didn't support that.

But Stram believed he could help her. Julia has been treated for a month and a half now, traveling from her Brooklyn home to Stram's office in Delmar. Three days a week, she receives antibiotics and nutrients intravenously. She believes she’s getting better.

“I’m starting to feel the bottom of my feet and wiggle my toes more," she said. "The miracle is coming and the pope made it happen."

But the young girl’s treatment might be cut short as she finds herself in the middle of an ongoing controversy.

The CDC estimates 300,000 people get Lyme disease a year in America. Ninety-six percent of the cases are reported from just 14 states, including New York, New Jersey, and Connecticut.

There is great disagreement on its diagnosis and treatment.

“We’ve seen numerous doctors, four different hospitals,” said Enrico Bruzzese, Julia’s father. “What’s so confusing is none of the doctors we saw had matching opinions.”

Bruzzese's insurance company, Emblem Health, has denied them coverage because Julia’s tests have come up "negative for Lyme disease."

Emblem Health, like most other insurance companies, refer to guidelines established by medical associations like the Infectious Diseases Society of America to determine when treatment is appropriate.

Dr. Gary Wormser of Westchester Medical Center is a lead author of guidelines for treating Lyme.

“In early Lyme disease infection, you may only get 1 out of 3 positives because it takes time for antibodies to produce,” said Wormser. “But patients who have been sick for months invariably will have a positive Lyme test.”

Wormser has not studied Julia's case but stands by the theory that she should have at least a minimum presence of Lyme antibodies. Stram showed NBC 4 New York Julia’s blood work, which shows some evidence of Lyme, but not enough to be covered by her insurance company.

In 2008, Connecticut’s then-Attorney General Richard Blumenthal uncovered serious flaws with the Infectious Diseases Society of America's process for writing Lyme guidelines, saying the panel "improperly ignored or minimized consideration of alternative medical opinion and evidence regarding chronic Lyme disease."
(...)
http://www.nbcnewyork.com/investiga...e-Fight-Investigation-360476931.html#comments

More in the link. Also the video reportage is available on the NBC page.
Very good responses in the comment section, by the way.
 

valentinelynx

Senior Member
Messages
1,310
Location
Tucson
I thought this was a pretty well done news story. Wormser quote was somewhat deprecated by the subsequent mention of the Connecticut investigation of IDSA.