Insurance

How to Respond to Insurance Denials
Based on IDSA Guidelines

Lorraine Johnson, JD, MBA, Chief Executive Officer, California Lyme Disease Association

Download Insurance Letter and Press ReleaseNow that the Connecticut Attorney General has released his findings of the antitrust investigation into the IDSA guidelines, what should you do about insurance denials? If you are denied insurance coverage for Lyme disease based on the IDSA guidelines, you should:

  • Send your insurer a letter objecting to the denial. Point out that the Connecticut Attorney General found the IDSA guidelines were seriously flawed and that the IDSA “allow[ed] individuals with financial interests—in drug companies, Lyme disease diagnostic tests, patents and consulting arrangements with insurance companies—to exclude divergent medical evidence and opinion”, specifically, evidence and opinions supporting the diagnosis and treatment of chronic Lyme disease. See sample attached.
  • Attach a copy of the Attorney General’s press release to the letter. See attached press release or go to: www.ct.gov/ag/cwp/view.asp?a=2795&q=414284
  • Send your State Attorney General a copy of your letter to your insurance company. You can locate your state Attorney General’s address at www.naag.org/attorneys_general.php

What do you do if your insurer does not respond to this request? Take it from Joanna Smith, a patient advocate who runs Healthcare Liaison Inc. in Berkeley, says "I always say to people appeal, appeal, appeal," she said. "And then appeal again." Follow all of your internal and external rights of appeal and call your state Attorney General to complain about your insurer. Although this will not always work, Attorneys’ General are becoming more active and more concerned about health care denials. Your job is to let them know your health care insurer is denying you medical care based on flawed guidelines that are under attack.