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Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.
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About 5 years ago, Dr Lerner tested daughter and I for Lyme as part of the initial standard battery of tests, so my guess is that he tests most of his patients for it. At that time, Dr L was using the standard Elisa (?) and Western Blot, not the newer tests. That may have changed in the past 5 years, of course.
Thank you for your reply and advice. I hope your son starts to pick up soon.
I wish you well and let us know if you go there. Our health care system leaves a little to be desired too..
@Jill I believe that what is billed to insurance may be different to what is billed to a person who doesn't have insurance.
Yes, insurance companies often negotiate down the charges with labs and clinics... an option the uninsured individual doesn't have. Their discount can be significant, so if you're paying out of pocket, it's important to know what the bill will be for the uninsured patient, not what an insurance company pays.
Thanks for all the replies. I'm unsure how to tag people or whatever - sushi and vasha.
Yes, this issue that @Sushi and @SOC pointed out is so important, @Jill. I think I have the "list price," the "insurance company discount," and my final cost, but I'll look. I also paid for some tests myself, before I had insurance, so I can look those up, too. They will be the "uninsured patient" price.
Heck, that's nothing for an ME/CFS specialist.
His waiting time does seem to be getting longer and longer. SOC is right.. We need more doctors !!
A lot depends on your insurance plan. If you have an HMO, you are probably out of luck. If you have a plan that allows you to choose your own doctor, you might have some luck. Even if the doctor doesn't submit directly to your insurance, some insurance plans will let you submit the bill yourself once you've paid, and maybe get reimbursed. It's worth a try, at least, although it's generally a major PITA.
You want codes for gut diagnoses for gut tests, cardiac diagnosis codes for cardiac tests, and so on. I imagine Dr Kaufman is very good about coding labs properly to get the best possible chance for insurance coverage, but I don't know that for certain.
A lot depends on your insurance plan. If you have an HMO, you are probably out of luck. If you have a plan that allows you to choose your own doctor, you might have some luck. Even if the doctor doesn't submit directly to your insurance, some insurance plans will let you submit the bill yourself once you've paid, and maybe get reimbursed. It's worth a try, at least, although it's generally a major PITA.
Which labs are covered often depends on your individual insurance plan. It all comes down to whether your insurance company deems the labs legitimate and necessary. It helps if your doctor puts the right diagnosis code on the lab request. If at all possible, you do NOT want the diagnosis code to be for CFS because the insurance company can legitimately claim no test is legit for CFS.
