Appeal, Appeal, Appeal
If you have an insurance policy issued by a company based in Virginia and have been denied reimbursement, you have several options available.
1. Contact the Virginia State Corporation Commission, Bureau of Insurance, specifically the Office of the Managed Care Ombudsman. It is best to call them first to be sure they can help you. There is no sense completing the required paper work if they can't help you. If you'd prefer to email them, their email address is listed below.
Phone: 877-310-6560 (toll free)
Email: ombudsman@scc.virginia.gov
Website with instructions and forms:
http://www.scc.virginia.gov/division/boi/webpages/boiombudman.asp
AND/OR.....
2. File a “quality of care” complaint with the VA Department of Health. You might want to ask why your insurance company is basing their decisions on IDSA treatment guidelines that have been found to be developed in a biased manner.
Website: http://www.vdh.state.va.us/OLC/Complaint/
Phone- Toll Free: 1-800-955-1819 or
Metro Richmond area: (804) 367-2106
Email: mchip@vdh.virginia.gov
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A transcript from a court case involving Lyme disease included testimony by an insurance executive. Bottom line- insurers sometimes flag Lyme cases and have been known to deny patients claims initially to save $$, but they usually will pay the claim if an appeal is filed.
So NEVER let it drop when you are denied. Fight for your rights! And make it easier on yourself by getting help from the above agencies when doing so. Some of them have been very helpful and surprisingly, very Lyme literate.
Good luck!