need LLMD for adult in San Diego, CA area, also Medicare questions

[EAMom]

Hi All,

 

I have a friend whose mom needs a LLMD. The mom lives 1/2 North of San Diego. She has Kaiser and Medicare. Please PM me with names and comments on doctors if you know of any in San Diego (or even LA).

 

I know Kaiser is bad news for Lyme! Does the Medicare help? Does anyone know if Medicare would help cover any of the "good" Lyme tests (eg Igenex and/or Advanced Labs Culture test).

 

Thanks!
Eamom

 

 

 

[JoyBop]

Medicare covers labs by laboratories they are contracted with and medically proven and backed by the FDA. exceptions can be made by a case by case decision when doctors write in for authorization. Have you tried the standard blood tests for western blot ect? Sorry I can't help with physicians in your area.

[EAMom]

Found this online which explains about insurance for a certain Lyme doc:

http://www.usmamed.com/usmaqa.html

How much will the lab work cost?

"If you have insurance, bring your insurance card with you and you may present this to LabCorp at the time of your blood draw. Most of your lab work will be billed directly to your insurance. If you do not have insurance and have to pay for your LabCorp labs out of your pocket, the cost of these will vary greatly, depending on what needs to be ordered. Make sure you ask the lab technician to tell you up front how much each test costs.

If you have an HMO, only lab work ordered by an in-network provider will be covered. Some patients are able to convince their HMO primary care provider to order some of the labs for them so that they will not have to pay for these out-of-pocket. Even if you have insurance, the tests we will order from the specialty lab, IGeneX, will need to be paid for up-front by credit card. The total charge for this lab work will be approximately $800. If you have Medicare there will be no charge for the IGeneX labs. (You must bring your Medicare card with you!) If your Medicare is managed by an HMO, however, your IGeneX lab tests will NOT be covered. If you have a PPO, you will be able to submit the receipt from IGeneX for reimbursement under your out-of-network expenses."

[Hopeny]

I knew someone ago had the entire slew of igenex tests that were covered by Medicare, it's the only thing igenex accepts

[EAMom]

Hopeny,

 

Since my friend's mom has Kaiser, I guess this means her Medicare is managed by Kaiser?? So maybe the Igenex tests won't be covered?

 

"If you have Medicare there will be no charge for the IGeneX labs. (You must bring your Medicare card with you!) If your Medicare is managed by an HMO, however, your IGeneX lab tests will NOT be covered."

[JoyBop]

Are you sure its not a "Medicare replacement plan"? This is a plan that will give you identical coverage and adheres to all medicated policies but is managed by a different company.

In other words, if Medicate covers it, the replacement covers it. Medicate pats for most lab work but must be "in network. ". A simple phone call to your insurance co ought to answer the question easily.

[EAMom]

@Joybop

 

Oh, I don't know. It's for my friend's mom. My friend said she has Kaiser. I asked if she also had Medicare, and my friend said yes. I don't really know much about Medicare but I'll ask my friend. It sounds like the mom is too sick to deal with all of this herself.

[JoyBop]

She might also have kaiser as secondary to medicare. It can be complicated but most companies will follow medicated rules and policy guidelines. A simple phone call to her primary insurance ought to clear things up very easily if she has the name if the lab and test.