Lyme culture test reimbursed by insurance?

[lfran]

Hi all.

 

Am thinking of biting the bullet to get Advanced Laboratory's Lyme culture test done. I know there is a 20% false negative rate, so I'm a bit scared of throwing money away. Does anyone know if insurance will reimburse for any of this test? I have Anthem Blue Cross, by the way.

 

Also, what do the LLMDs think about this test? Any feedback from them?

 

Thanks.

[philamom]

No reimbursement here.

[lfran]

Did you submit and they said "No"? When they refuse, is that a "ding"? This is my first time dealing with a PPO.

 

 

 

No reimbursement here.

[philamom]

It was denied after submitting. I forget, but I think the lab could not provide the information they were asking for. I'd also be curious if anyone got reimbursed. It may be worth revisiting the claim.

Edited October 28, 2012 by philamom

[LNN]

FWIW, my LLMD continues to rely more on Igenex and clinical picture and has only used Advanced Labs a handful of times. In one case, it came back negative when he was all but certain the patient had lyme. We didn't discuss it at length but I gather that his objection is over the price and reliability. His view was that lyme doesn't stick around in the blood - it tends to colonize in soft tissues or films. So the "needle in a haystack" issue is there - possible to draw a vial of blood and have no lyme in that vial, plus it's double the cost of Igenex without giving him any higher assurance that a negative isn't really a positive truly is negative. He'd rather see patients put the money toward treatment. Now if the test were less expensive, he may feel differently. IDK.

 

My personal opinion is that it may be a better test for someone who's gotten ill recently, like within the first few months. For those who are chronic, the accuracy may drop. If I were just starting out and had a cash reserve, I think I'd be tempted to do it. But if the cash situation was rough, I might go with Igenex and if there were IND bands, put trust in those. When the Advanced Labs test first came out, I was really excited. How can you argue with a picture of a spirochette from your own blood? That kind of reassurance that you knew you had lyme would be awesome. So if you have the cash, I could argue it was worth doing. I would just do it with the understanding that a negative might leave you in the limbo you're in now.