Spinal Tap

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Just_Me
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Spinal Tap

Post by Just_Me » 8 years ago

Have any of you (or anybody you know) been denied insurance benefits because of a negitive spinal tap?

I was told a year ago I had progressive MS. I didn't feel confident with the doctor and started looking into Lyme. My Lyme test with Igenex was what I'd call a "maybe". A lyme doctor I am seeing says she is convinced I have lyme. I was on abx for a while until I had stomach problems and haven't started again.

I went Mon to see a neurologist at UCLA. She said she thinks its likely MS. So the MS doc thinks its MS and the lyme doc thinks its lyme. To be honest I expected this.

Anyway, the MS doc thinks I should get a spinal tap but I thought I read that if it came back negitive (especially negitive for lyme) it could give the insurance company a reason to deny treatment. The MS doctor says its not true. I have Anthem BC if that makes a difference.

Any thoughts?

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patientx
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Post by patientx » 8 years ago

I couldn't say for certain, and every insurance company is different, but I really doubt they would deny you treatment based on the spinal tap (LP). From what I was told, the LP is not indicative of MS in about 20% of cases, so if it's negative that doesn't rule MS out. In fact, many places don't even use it, and rely mainly on MRI and clinical signs (I didn't have one, because I was told it wasn't needed for diagnosis). Also, usually if the doctor gives a diagnosis, that's all the insurance company requires to cover medication.

So, if you get the spinal tap to try and find extra evidence for MS, in my opinion, I wouldn't worry about it affecting the insurance.

I would be careful to ask the neuro about putting a label on what type of MS you have (i.e. progressive or RRMS). Because, if you do want to give a DMD a try, the insurance company may not cover a DMD if your are diagnosed progressive. But, I do not know this for sure.

Also, I'd be a little wary with the lyme docs.

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