If you get Lyme disease, will your health insurance cover treatment?
When a diagnosis of Lyme Disease is made, the conventional treatment is two weeks of the antibiotic doxycycline — but that is not effective in all cases.
Pat Smith, the president of the Lyme Disease Association in Jackson says it may take several additional weeks or even months of treatment to wipe out the disease and “many insurers will not cover long-term, which is something of course we have been working a long time to try to overcome.”
“Generally insurers will cover a short term, a few weeks of antibiotics, but when it comes to covering more, more, that’s where the problem lies," Smith said.
She said the Infectious Diseases Society of America continues to describe Lyme disease as is a short-term issue that is eradicated by a few weeks of antibiotics, even though it’s become clear “some patients need not just weeks more but might need months more or longer depending on what their symptoms are.”
"Most cases of Lyme disease are successfully treated with a few weeks of antibiotics," the IDSA says on its website. "Using antibiotics for a very long time (months or years) does not offer superior results and in fact can be dangerous, because it can cause potentially fatal complications.
“It’s a big battle and insurers have been pretty adamant in a lot of cases not to pay, and of course they feel it’s too their benefit," Smith said.
She said, however, not treating Lyme properly early on can increase the cost of medical treatment for a variety of symptoms down the road.
Smith said efforts to force the issue of health coverage have been ongoing since the 1990s, but so far the Legislature has been reluctant to mandate longer coverage times for Lyme.
Assemblywoman Nancy Munoz (R-Union) is the prime sponsor of legislation that would require health insurance companies to cover the entire cost of Lyme disease treatment suggested by a doctor.
“You should remain on a treatment course for as long as it takes to treat the disease, the illness, whatever it is," Munoz said.
She pointed out some medical experts believe that in order to eradicate Lyme disease “it’s a long-term treatment and in order to be effective you need to go as long as is medically necessary, the patients should be covered for the treatment.”
She said under that scenario, long-term health issues and problems that can affect people’s lives for decades can be prevented.
The legislation is still pending in the Assembly Health Committee, and has not been scheduled for review yet.
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You can contact reporter David Matthau at David.Matthau@townsquaremedia.com