Lyme Disease Medical Bills | Insurance Billing Solutions2018-07-29T18:06:02+00:00

LYME DISEASE MEDICAL BILLS

FREQUENTLY ASKED QUESTIONS

The medical billing advocates at Medical Bill Gurus have over twenty years of experience in helping patients work through the complex financial issues associated with healthcare.

Medical Bill Gurus is a medical billing advocate / patient advocacy service that assists patients of all backgrounds with medical bills and the financial complications associated with healthcare. Our medical bill advocates have over 20 years of experience help patients, such as yourself, reduce or eliminate their medical bills. To have one of our medical billing advocate evaluate your case free of charge, Schedule A Free Case Evaluation.

Medical Bill Gurus offers all medical billing advocate and patient advocacy services on strictly a contingency basis, such that there is no fee unless we are successful in securing reimbursement for you. If we are successful in securing reimbursement, then the service fee would be 20%. If we are not successful, then there is no fee or financial obligation whatsoever.

Yes, as Medical Bill Gurus offers services on a contingency basis only, our fee is based solely on the amount of money you actually receive back from the insurance. Thus, we do all of the billing up to the deductible free of charge as a value to our clients.

If you received treatment at an out of network medical provider, such as a cash only LLMD, then you would need to have a private insurance policy that is a PPO with out of network benefits. As most alternative medicine providers are out of network, your policy needs to be a PPO. Unfortunately the facts outside of my control and everyone’s else are that medicare, medicaid, and HMO insurance policies will only provide reimbursement for providers that are in-network.

Medical Bill Gurus is able to assist with medical bills from any provider, as long as we have the necessary documentation to put together bills on your behalf. We are currently working with medical providers throughout the United States, Germany, Mexico, and various other countries. If there are specific requirements for your provider, we would discuss how to move forward during your free case evaluation.

Yes, Medical Bill Gurus can help process bills on your behalf for treatment at ANY medical provider. We are currently working with various clinics throughout the United States, Mexico, and Germany.

The time period that dictates how far back our medical billing advocates can retroactively submit claims is dependent on your specific policy. The average timeframe we can bill for treatment is up to 12 months, but can vary between 6 – 18 months depending on your policy. We recommend you call you insurance carrier directly to ask them how far back you can submit claims.

In-network refers to those providers have negotiated contracted rates with the major insurance companies, such that insurance company has full control over how much that provider is reimbursed.

Out-of-network refers to providers who do not have negotiated rates or contracts with the major insurance carriers, and set their own rates of treatment and services rendered.

Out of network providers include alternative medicine providers and cash only providers, such as LLMD’s, Lyme Clinics, international providers in Mexico & Germany, and any provider without a contract with the major insurance carriers.

Once Medical Bill Gurus receives all of your completed paperwork, and copies of your medical bills, it will take our team 4-5 weeks to process your bills. Once we submit your bills to the insurance company, it typically takes 60-90 days before a claims decision is made.

Unfortunately, as Medicare and Medicaid do not have out of network coverage, we are unable to process claims.

To get started, we simply need you to complete the FORM above, and send us a completed copy of the Medical Bill Gurus paperwork, as well as copies of any medical bills. Once you submit your information, you will also be given the option to set up a time to speak with one of our medical billing experts regarding your case.

For each treatment listed on the provided medical bills, we identify the FDA approved treatments and FDA approved ancillary services such as doctor consults, treatment room, medical supplies, lab test and admin of the treatment), which can make up a substantial amount of the bill. At this point we will start getting an idea of what treatment the patient had done, and identifying which line items and associated costs we can submit for reimbursement to the insurance. For example on truly alternative services such as ozone therapy, stem cells, and IV infusions, we would be able to bill for doctor consults, supplies, facility, and then potentially for the truly alternative component for treatment depending on what was done.

As stem cells are considered experimental and alternative in nature, we are not able to bill for the full price of treatment. However, we are able to bill for the FDA approved ancillary services, which can make up a significant financial component of treatment. For example on a $25,000 stem cell + IV therapy treatment protocol, we would be shooting to recover potentially $5,000-$15,000 of the amount spent on treatment.

Yes, IV therapy is actually one of the treatment protocols we have had the best success with. As long as we have a itemized breakdown of treatment, also known as a “super bill”, we can put together your bills. For IV therapy, depending on the amount spend, your bills, and if you have met your deductible, we could potentially recover 40-60% of what was spent.

Did you have any additional questions about how our medical billing advocates can you with Lyme Disease Medical Bills or any other out of pocket medical expense? Feel free to sign up below for a free consultation on how to interpret your insurance policy, as it relates to your past, current, or upcoming treatment.

Sign Up Today For A Free Case Evaluation

Our experts are experienced with handling Lyme Disease Medical Bills, & understand how the alternative cash only providers operate.

If you would like to see if your Lyme Disease medical bills qualify for our services, submit the form below, and our experts will be in touch 🤠

Sit back while we take care of everything. And the best part 😬? You only pay us if we successfully get you a reimbursement from the insurance

The #1 Question Patients Have:

Question:

How Much Money Will Get Back Even If I Do Qualify?

Answer + Explanation: 

Depending on the insurance carrier, quality of the policy, level of coverage, deductible, and endless variables, Medical Bill Gurus has been able to help patients secure insurance reimbursements for treatment at cash only medical providers that out of network with the major insurance carriers.

As for any other clinic or medical provider that we work with, we can always bill for the FDA approved and FDA approved ancillary services. For example, this would include labs, doctor consults, certain components of IV therapy, injections, etc., but not supplements or non-FDA approved services.

It is important to realize that if you are only receiving stem cells, that we would be limited in what we could bill for, as stem cells alone are not FDA approved in the eyes of the insurance, and have limited FDA approved ancillary services that we can bill for.

However, if you have IV therapy and other services in your treatment protocol, then we would be able to potentially bill for more and help secure reimbursements.

The facts outside of my control and everyone’s else are that medicare, medicaid, and HMO insurance policies will only provide reimbursements for providers that are in-network.

In-network refers to those providers have negotiated contracted rates with the major insurance companies, such that insurance company has full control over how much that provider is reimbursed.

Out-of-network refers to providers who do not have negotiated rates or contracts with the major insurance carriers, and operate in a more independence fashion.

Alternative medicine providers and cash only providers, which typically include LLMD’s, Lyme Clinics, international providers in Mexico & Germany, and any provider without a contract with the major insurance carriers.

It is the personal choice of that particular medical provider whether or not they are in-network with the major insurance carriers.

However, due to low reimbursements and fear of action towards them, most LLMD’s and Lyme Clinics choose to be out of network and rely solely on cash payments to run the business side of their practice.

Now, bringing this back to what insurance you need to have in order get reimbursed, your policy will need to have out of network coverage if you plan to or have received at a cash only medical provider, such as a LLMD, Lyme Clinic, or other provider that requires cash payment for treatment.

A PPO (Preferred Provider Organization) is an insurance policy that allow you to visit whatever in-network physician or healthcare provider, as well as out of network healthcare provider, you wish without first requiring a referral from a primary care physician.

Bringing this full circle, in order for any treatment at a cash only provider to be covered, you need a PPO, whether it is for a local family doctor who it is in network or a Lyme Doctor that is out of network.

Regarding access to PPO policies, I believe that the state of insurance coverage in our country is diminishing by the day, and that the average person is left with dwindling coverage when they actually need to use their policies.

One of the hardest conversations I have on a daily basis is talking with Lyme patients and families who have hundreds of thousands in medical bills, only to tell them that their insurance, which is offered by their employer is not adequate to help them get coverage.

A lot of time the frustrations immediately turn to Medical Bill Gurus, but I do my best to educate everyone, and help them understand the back working of our broken healthcare system.

Depending on how your policy is written, you are going to typically have a separate deductible and max out of pocket for both in network and out of network.

Until you reach your deductible, typically your insurance will have you either pay the amount of covered reimbursable charges or cover a percentage of them, this percentage is called your co-insurance.

I want to make a key point here, that in the world of Lyme and cash only providers, the insurance will not deem the amount they charge as the typical and customary rate they will use to define the amount of reimbursement.

For example, if you have a consult with a LLMD, and it costs your $599 for a one hour consult, which by any means is a significant amount of money.

However, the insurance company will cover this at the usual and customary rate they feel is justified, which may lead to them saying that consult was only worth $199, that you can apply towards your deductible.

If you have a $5,000 deductible, then only $199 of the $599 you spent would be applied, and you could potentially need to spend $25,000 to hit your $5,000 deductible.

Being more optimistic, your insurance could cover it at 80%, and you could have $450 of the $599 applied to your deductible and reimbursements, which is how we arrive at the range of $0-$17,000 back for treatment at Infusio.

Another question I get a lot is about supplements, unfortunately we are not able to get supplements covered.

Once you reach your deductible, then that co-insurance value change or kick in to provide a higher level of reimbursement from the insurance.

As you continue to spend more, you will eventually hit your max out of pocket which represents the threshold at which the insurance will cover 100% of all services and treatments they deem reimbursable.

The scenario I described above occurs for both the in-network and out of network options, depending on where you received treatment.

No two policies are ever the same, so it is important you look at your specific policy and identify the defined milestones so you know what the following:

  1. Do you have out of network benefits?
  2. What is your out of network deductible?
  3. What is your out of network max out of pocket?
  4. What is the coinsurance for out of network claims?
  5. How far back can I submit claims retroactively to the insurance for out of network providers?

Next if you are trying to figure out a realistic number of how much you can potentially get reimbursed by the insurance, do not assume that you will get the full amount spent on treatment covered at that price.

There are so many variables with nothing being guaranteed with the insurance, so that is why when we take on client to help them with their bills we all of the billing up to the deductible free of charge, and work strictly on a contingency basis.

In our experience, we can actually lose money as some carriers such as Blue Cross Blue Shield literally pay pennies on the dollar to what people are spending, so depending on the quality of the policy, we can think that a client will get a certain amount back as they spent a ton, only to find the insurance considered 5% of that amount reimbursable which was barely enough to meet the deductible.

I never make promises, because this is just one more example of the current state of our healthcare system, and how it is a black box to try and figure what things cost and what is deemed a fair reimbursable rate.

PRESIDENT/FOUNDER

Daniel Lynch, EIT

LEARN IF YOU QUALIFY
LYME DISEASE MEDICAL BILL SOLUTIONS

1. Eligibility

Patient, friend, or caregiver reaches out to Medical Bill Gurus regarding Lyme Disease medical bills and we collect basic contact info (name, email, phone address), insurance information (type of insurance, group #, id #, copy of policy benefits), and medical provider info (clinic / diagnosis).

Medical Bill Gurus specializes in helping patients with Lyme Disease medical bills for treatment at cash only medical providers that do no accept insurance upfront at the time of treatment.

To initiate the insurance reimbursement process for Lyme Disease medical bills, our insurance experts will need to evaluate your insurance policy to identify what coverages are available on the policy. Historically, a patient would need to have a PPO with out of network benefits.

Unfortunately, we are unable to help patients get reimbursed for policies that lack out of network coverages such as HMOs, Medicare, Medicaid, or any state/government run insurance due to the lack of out of network coverage.

In this first step, our insurance experts would also want identify the medical provider, and their status as a provider. If the patient received treatment internationally, then we would want to verify the insurance policy has international coverage to cover Lyme Disease medical bills at clinics internationally, particular Germany or Mexico.

2. Application

The next step is our insurance experts to obtain a copy of the Lyme Disease medical bills, particularly a “superbill” such that all treatment is itemized. At this point our insurance experts will then analyze the medical bill to break down the treatment protocols the best we can into the FDA approved ancillary services.

Once we have broken down the Lyme Disease medical bills, we will move forward to start processing the Lyme Disease medical bills, or we will have to reach out to the medical provider in the hopes they will provide more detailed information on the treatment. Ex: some clinics are notorious for given a receipt that just says two line items, which is not anything we can use.

At this point, in order to move forward, we need an itemized breakdown of what treatments the patient had done on which dates of treatments. For each treatment listed, we are going to identify the FDA approved treatments and FDA approved ancillary services such as doctor consults, treatment room, medical supplies, lab test and admin of the treatment), which can make up a substantial amount of the bill.

3. Review Process

Once we have broken down everything and created a new itemized bill for the insurance, we will submit everything on behalf of the patient, and send it off to the insurance company. It typically takes 60-90 days to hear a decision from the insurance company.

We have a commitment to ensure that the patients we help received the most sound and up to date financial advice regarding medical bills,  health insurance, and the financial component of healthcare.

4. Success

You will receive a check in the mail directly from the insurance company.

If we are successful, you should receive a check directly from the insurance company within 60-90 days. We can not guarantee anything other than we will do our best to evaluate your claim and pursue any underpayments per your insurance policy. Once you receive a check, we will send you an invoice for a percentage of whatever we collected. If we did not collect anything, then there is no fee whatsoever, and we lose money for taking on the case.

You Have Medical Bills, We Have Financial Solutions

You Have Medical Bills, We Have Financial Solutions

TESTIMONIALS

Mary Casanova
Lyme Disease
Lyme Disease Treatment

After spending $40k out of pocket for 10 days of Lyme Disease treatment at a cash only clinic in Arizona, Medical Bill Gurus was able to recover $18k from the insurance. I thought I would (...)

The main reason Lyme Disease is difficult to detect is because the symptoms can be obscure. Due to the obscure symptoms associated with Lyme, the disease is often referred to as the Great Imitator as it commonly imitates the symptoms of other illnesses. Lyme Disease is often misdiagnosed as numerous conditions and diseases, including but not limited to: Autism, Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s, Crohn’s Disease, Chronic Fatigue Syndrome, Fibromyalgia, Irritable Bowel Syndrome (IBS), Lupus, Parkinson’s, Prostatitis, or Multiple Sclerosis, just name to a few.
Nick Schwartz
Lyme Disease

I have suffered from Lyme Disease for 15+ years, and never thought insurance would help pay for treatment. Now I am able to get money back that I can use to afford long term treatment protocols.

Unfortunately, Crohn’s Disease is a chronic disease, which means long term. There isn’t a quick fix where the doctor will prescribe a one-time antibiotic and you are done. While it’s manageable, it comes back, repeatedly. And, there are approximately 700,000 Crohn’s Disease patients in the U.S. alone. Crohn’s Disease causes aggravating inflammation within the digestive tract, as well as deep and painful sores, otherwise known as ulcers. It typically attacks the ileum (lower part of the small intestine), and the colon (the upper part of the large intestine). And, although different, it’s often compared to Ulcerative Colitis, which is another chronic disease that causes inflammation of the colon. The two of these diseases are linked into a group of diseases that involve the digestive tract, and referred to as Inflammatory Bowel Disease, or IBD. Crohn’s Disease and Ulcerative Colitis both have an ebb and flow pattern as they go into stages of both remission and relapse. And, with proper treatment, diet and exercise, the remissions can be greater than the relapses, allowing people living with the diseases to live a somewhat normal lifestyle. We will address this further in another article.
Katherine Anne

For a few years, I had stomach pain that caused me to go to the ER on what like a nightly basis. Each visit was another bill and another doctor telling me nothing was wrong, and before my (...)

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Dr. Charles Rogers, MD
Dr. Charles Rogers, MD
Medical Billing For Physicians

Had I known about Medical Bill Gurus 30 years ago, I would have had the opportunity to impact the lives of more patients. I initially agreed to contract with Medical Bill Gurus because of the (...)

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Summary
Lyme Disease Medical Bills | Patient Advocate
Service Type
Lyme Disease Medical Bills | Patient Advocate
Provider Name
Medical Bill Gurus,
3000 Lawrence Street Suite #15,Denver,Colorado-80205,
Telephone No.1-800-674-7836
Area
United States
Description
Medical Bill Gurus specializes in helping patients with Lyme Disease medical bills for treatment at cash only medical providers that do no accept insurance upfront at the time of treatment. To initiate the insurance reimbursement process for Lyme Disease medical bills, our insurance experts will need to evaluate your insurance policy to identify what coverages are available on the policy. Historically, a patient would need to have a PPO with out of network benefits. Unfortunately, we are unable to help patients get reimbursed for policies that lack out of network coverages such as HMOs, Medicare, Medicaid, or any state/government run insurance due to the lack of out of network coverage. In this first step, our insurance experts would also want identify the medical provider, and their status as a provider. If the patient received treatment internationally, then we would want to verify the insurance policy has international coverage to cover Lyme Disease medical bills at clinics internationally, particular Germany or Mexico.