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Is Lyme Disease Test Covered By Insurance


The Need For Insurance Coverage For Lyme

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The topic for my law journal article came from hearing stories of other patients struggling to receive insurance coverage, as well as my own personal experience. If patients are not able to pay for their medical treatment because public or private insurance does not cover it, they will likely not get better.

I wanted to provide federal legislators with strong scientific evidence, a background on the controversies associated with the illness and a concrete way to improve the lives of patients who are currently suffering.

My goal was to build on the work of local activists who have achieved incredible results passing legislation in some states, by expanding coverage on the national level.

Insurance coverage is especially critical in states with perceived lower incidence rates because it may not be a priority for those states legislators. My proposal is based on other federal insurance laws including the Federal Parity Law and the Womens Health and Cancer Rights Act.

Since Lyme disease patients live in every state in the U.S., federal legislation will provide insurance coverage for patients no matter where they live.

Jennifer Barrett will graduate from law school this spring.

Question 10 What Other Infections Can A Tick Transmit To Humans Besides Lyme Disease

I scapularis ticks can also carry other human pathogens that have a high degree of symptom overlap, including Borrelia miyamotoi, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Babesia microti.2,10-12 Several studies on co-infected ticks indicate as many as 20% of Ixodid ticks can be coinfected with B burgdorferi and one or more of these other tick-borne human pathogens.10-12

Molecular tests can be useful to detect these organisms in early/acute stages of infection, when genetic material from the pathogen can be detected but antibodies remain below the limit of detection of serologic assays.2,10-12 Quest offers molecular and/or serological tests for B burgdorferi, B miyamotoi, A phagocytophilum, E chaffeensis, and B microti, individually and in 2 panels .

What Is The Most Accurate Test For Lyme Disease

Lyme disease is more common than many people think. Figures from the Center for Disease Control suggest that roughly 300,000 Lyme disease cases occur every year in the US.

The numbers are alarming, but it gets worse as finding accurate diagnostic tests can be challenging. Although the disease is treatable, it is nearly impossible to tackle it effectively if it is not diagnosed accurately and early enough.

Late detection can lead to severe health problems such as arthritis, heart blockage, and inability to concentrate, among other problems.

Given the prevalence and seeming elusiveness of the disease, some of the logical questions concerned persons would ask are: what is the most accurate test for Lyme disease? And when should I get checked for Lyme disease? This article will proffer answers to these and many other related questions. But first, a little background would be in order.

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Stage : Early Disseminated Infection

Early disseminated Lyme disease occurs several weeks after the tick bite. During this stage, bacteria are beginning to spread throughout the body. Its characterized by flu-like symptoms, such as:

  • Chills
  • Muscle aches
  • Headaches

During early disseminated Lyme disease youll have a general feeling of being unwell. A rash may appear in areas other than the tick bite, and neurological signs such as numbness, tingling, and Bells palsy can also occur. This stage of Lyme disease can be complicated by meningitis and cardiac conduction disturbances. The symptoms of stages 1 and 2 can overlap.

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The Blood Tests Can Have False Positives

Bill Would Require More Insurance Coverage For Tick

The blood tests can trigger false positives, suggesting that you have the disease when you really dont. This can happen in up to one out of four tests.

This can lead to unnecessary treatment with antibiotics. These drugs are usually safe, but they sometimes cause side effects, such as nausea, vomiting, diarrhea, and increased sensitivity of the skin to sunlight. In rare cases, they can even cause dangerous allergic reactions.

Using too many antibiotics can also lead to the growth of drug-resistant bacteria. This means that bacteria in your body may get stronger and more difficult to treat with antibiotics in the future.

A false positive can also lead to more unneeded blood tests, urine tests, X-rays, and doctor visits.

If you have a false positive, you may not get treated for the real cause of your pain. For example, rheumatoid arthritis is a disease that causes joint pain. It can lead to permanent and severe joint damage if you do not start taking the right medicines as early as possible.

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Cutter Lyme Disease Tick Test

The Cutter Lyme Disease Tick Test is a DNA tick test that checks whether the tick carries a Lyme disease pathogen.

The test requires a person to take one to several ticks from the same host and place them in the specimen bag. They then mail them to the lab using the pre-addressed mailing label.

Individuals can expect to receive their results through email, phone, or mail within 3 business days. The available screenings feature basic, advanced, and comprehensive test panels that check multiple pathogens.

At the time of publication, this test costs $25.

Pros and cons

This test features several advantages. Reviews state:

  • It is easy to use.
  • It is affordable.
  • People can use it on their pets.

However, it does not test for other infections that ticks carry.

Question 3 Is There A Molecular Test For Lyme Disease

One example of a molecular test for Lyme disease at Quest is the Lyme Disease DNA, Qualitative Real-Time PCR, Blood . Amplification of Borrelia genomic DNA from blood, fluids or tissues can support the diagnosis of Lyme disease. Click here for a list of this and other molecular tests for Lyme disease at Quest.

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Why It Is Done

A Lyme disease test is done to diagnose Lyme disease in people who have symptoms of Lyme disease. Symptoms may include:

  • An expanding red rash with a pale center. This is sometimes called a “bull’s-eye” rash.
  • Extreme tiredness.
  • Headache and stiff neck.
  • Muscle and joint pain.

Symptoms of chronic Lyme disease infection include joint pain, stiffness, and problems with the heart, brain, or nerves.

Testing is most accurate when you have risk factors for Lyme disease or symptoms of the disease.

How Much Does A Lyme Disease Test Cost

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In most cases, if theres a clear sign of Lyme disease a painless rash spreading, similar to that of a bullseye then your doctor often wont recommend a test unless you were in an area known for Lyme disease. Instead, your doctor will recommend antibiotics, which, even if you dont have insurance, should cost less than $30 at your local pharmacy.

The antibody blood tests, the most commonly used tests, if you were to want one and/or your doctor recommends it, then a simple Lyme disease test can cost close to $250 without insurance, in addition to the doctors visit. This cost will really depend on the type of Lyme disease blood test you want. Again, your doctor, after performing a thorough physical exam and examining your medical history, will recommend the blood test if you were in an area known for ticks with Lyme disease and/or have symptoms such as a fever, swelling in your joints and/or warmth in the knees, shoulders or wrists.

Type of Test
Complete co-infection panel $700 + doctor’s visit

According to this message thread on MetaFilter.com, a few members talked about what a Lyme disease test could cost, and most expected the total costs would be in the $300 to $700 range, with one member claiming he paid $700 for his son without health insurance.

The cost of an IGeneX Lyme disease test, for example, can cost $250 to $660, according to LymeDiseaseGuide.net.

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Question 4 What Tests To Assist In The Diagnosis Of Lyme Disease Are Available At Quest

Serologic testing is the principal means of laboratory diagnosis of Lyme disease. Quest offers testing in accordance with the Centers for Disease Control and Prevention guidelines for early/acute Lyme testing.3 When laboratory diagnosis is indicated, current recommendations include using a 2-tier testing approach that begins with a sensitive enzyme immunoassay , followed by a confirmatory immunoassay for specimens yielding positive or equivocal results.3 In the standard 2-tier test algorithm, a Western blot or immunoblot assay is used for confirmation. However, on July 29, 2019, the US Food and Drug Administration cleared several Lyme disease serologic assays with new indications for use, which allowed an EIA to be used as the confirmatory test in a modified 2-tier testing algorithm.3 The MTTT algorithm is now considered an acceptable approach for the serologic diagnosis of Lyme disease and may be able to assist in the identification of early Lyme disease within the first 30 days of infection.3

Quest offers test options that use both the STTT and the MTTT algorithm:

  • STTT: Lyme Disease Ab with Reflex to Blot
  • MTTT: Lyme Disease Antibody with Reflex to Immunoassay

Click here for a complete list of additional tests for tick-borne infectious diseases available from Quest.

When Not To Take This Lyme Disease Test

Do not take this Lyme disease antibody test if:

  • You are experiencing a round rash after a tick bite, such as the typical bullseye rash associated with early Lyme disease. Seek immediate medical attention instead of taking this test. A round rash could be a sign of Lyme disease, and its best to consult a medical professional and receive treatment as soon as possible to help prevent complications associated with the disease.
  • You suspect you might have been infected with Lyme disease bacteria less than 6 weeks ago . The antibodies detected by this test take several weeks to build up in your bloodstream, taking the test before 6 weeks have passed may result in a false negative.
  • You havenât lived in or traveled to an area where Lyme disease occurs. Consider discussing any symptoms with your healthcare providerâinstead of taking this testâto help determine if youâve been exposed to a Lyme disease bacterium.
  • Youâve previously received a Lyme disease diagnosis, was treated for the disease, and are still symptomatic. Consider discussing any new or ongoing symptoms with your healthcare provider instead of taking this test.
  • You are currently being treated for Lyme disease infection or taking antibiotic treatment for other infections. Consider discussing any symptoms with your healthcare provider instead of taking this test.

Because interpreting Lyme disease test results can be difficult, weâve designed your test results to be easy to read and understand.

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Lyme Disease Test Cost With Insurance

Most of the health insurance policies in the U.S. do not cover the cost of the Lyme disease test. Because testing for Lyme disease is challenging and can lead to unnecessary diagnoses and costs. However, the coverage offered by private health insurance companies and national health insurance programs like Medicare and Medicaid varies widely. So we recommend you to check the coverage of your health insurance plan before getting tested for Lyme disease.

Our Lyme disease testing providers do not accept any kind of health insurance plan. But, if the insurance company accepts to reimburse the cost, they can provide you with an itemized receipt containing all the details like the name and code of the test, and CPT code that is necessary for insurance reimbursement purposes.

Is Lyme Disease A Preexisting Condition

Lyme disease bill could extend coverage beyond 30 days  Boston 25 News

Because chronic Lyme disease is not officially recognized by the CDC, it is not considered a preexisting condition by insurers. But under the Affordable Care Act, it is illegal for health insurance companies to discriminate against anyone with preexisting conditions, regardless of what that condition is. A Lyme disease diagnosis, whether short-term or chronic, cannot cause your insurance rates or coverage to change.

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Which Parts Of Medicare Cover Blood Tests

Medicare Part A offers coverage for medically necessary blood tests. Tests can be ordered by a physician for inpatient hospital, skilled nursing, hospice, home health, and other related covered services.

Medicare Part B covers outpatient blood tests ordered by a physician with a medically necessary diagnosis based on Medicare coverage guidelines. Examples would be screening blood tests to diagnose or manage a condition.

Medicare Advantage, or Part C, plans also cover blood tests. These plans may also cover additional tests not covered by original Medicare . Each Medicare Advantage plan offers different benefits, so check with your plan about specific blood tests. Also consider going to in-network doctors and labs to get the maximum benefits.

Medicare Part D provides prescription drug coverage and does not cover any blood tests.

Question 2 How Is The Diagnosis Of Lyme Disease Made

Diagnosis of Lyme disease is made through clinical assessment or clinical assessment supported by laboratory testing. The presence of an erythema migrans rash is diagnostic of Lyme disease without laboratory investigation.1,2

Patients who do not develop a rash but have symptoms suggesting Lyme disease, and have been to areas with a high risk of tick exposure, may undergo laboratory testing to help identify the cause of symptoms.1,2 For more information, see the Quest Diagnostics Clinical Focus Tick-borne Diseases: Laboratory Support of Diagnosis and Management available here.

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What Is Lyme Disease

Lyme disease is a tick-borne infectious disease caused by the bacterium Borrelia burgdorferi. This infection is mostly spread through infected deer tick or black-legged tick. As the ticks are very tiny, many people dont realize when they are bitten. But the longer the infected tick stays on your body, the higher the risks of contracting Lyme disease.Any person who lives or spends more time in a grassed or heavily wooded area is more likely to get this infection. So it is very important to take common precautions such as covering up the exposed skin and using insect-repellents.

Are Lyme Disease Tests Accurate

Just a test, take 1. Bloodstone cover.

Most at-home Lyme disease test kits screen for certain IgG and IgM antibodies that are part of the immune response against an infected tick bite. It takes time for these antibodies to appear in the bloodstream, and therefore a Lyme disease test will typically be most accurate once these antibodies have developed.

If you take a test too early, you may receive a false negative, as antibodies are not yet present in the blood, despite you having the infection. It takes between four and six weeks for antibodies to be detectable.

Whether you test positive for Lyme disease antibodies or not, you should still follow up with your healthcare provider. The results of an at-home Lyme disease test should not be taken as an official diagnosis for the condition.

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Question 8 Is There A Test To Prove Cure For Lyme Disease

There is no test to prove cure for Lyme disease. Antibodies frequently persist in the blood for months or even years after the infection is resolved, despite absence of detectable/viable B burgdorferi.7 Therefore, antibody tests cannot be used to determine a cure. There is no evidence that antibiotics cause Lyme serology blood tests to become negative following treatment.3,5,6

Why Is Lyme Disease Not Covered By Insurance

As the country recovers from the coronavirus pandemic that swept across the globe, another pandemic is lurking in their backyard. Tick season is here and thousands of families will begin to experience the impacts of forgotten tick bites received during the spring and upcoming summer months only to begin a journey of education and acceptance.

Unaware of the potential complications and financial resources required, thousands of families will begin to visit dozens of doctors that will span over the course of years and potentially decades to pursue alternative treatment that is often stigmatized by the medical community and not covered by insurance companies.

According to the Centers for Disease Control and Prevention , Lyme Disease is the fastest growing vector-borne, infectious disease in the United States, overtaking Zika Virus and West Nile Virus, with the number of cases reportedly increasing annually nearly 25-fold since reporting began in 1982.

The Centers for Disease Control and Prevention estimates that there are currently 300,000 new cases of Lyme Disease each year, but they state there are no accurate tests to quantify the number of new cases, which could well be in the millions.

A tick bite and bulls eye rash are the two most common physical markers for an infection of the spirochete bacteria known as bacterium borrelia burgdorferi, which is transmitted to humans through the bite of infected black-legged ticks.

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How Do My Top Picks Compete On Price

The Lyme disease tests on this list are relatively close on price. The test from Personalabs is the cheapest, but for the low cost, you need to visit a testing location to provide your samples.

The tests from Everlywell and LetsGetCheckedare comparable on price and while affordable, regularly offer special discounts that bring down the cost further.

If you have existing DNA data to upload, SelfDecode offers low-cost and free DNA wellness reports on much more than your predisposition to chronic Lyme disease for active subscribers. If youre interested in learning more about your genetic predispositions, SelfDecode provides excellent value-for-money.

Going From Doctor To Doctor

Chiropractic Care and Lyme Disease

I went from doctor to doctor trying to find the cause of my symptoms. Every time I went to the ER, they gave me a pregnancy test and discharged me. One ER doctor refused to give me a Lyme test. Another refused to believe my positive Lyme test and instead told me that I was attention-seeking and psychosomatic.

When my CDC-approved blood antibody test came back positive for Lyme, I thought I was finally on the road to recovery. My primary care provider prescribed antibiotics, and after a few weeks of treatment, I felt fantastic. My neck pain was gone, I was no longer dizzy, and I was finally sleeping.

But when I followed up with an infectious disease doctor, he attributed my positive test results to the fact that I had Lyme when I was younger and attributed my sudden regain of health to the anti-inflammatory agents in antibiotics. He prescribed a test for every infectious disease he could think of and ordered me to stop taking antibiotics.

But as each test came back negative and my symptoms began to flare, the doctor had second thoughts. He agreed to treat me with IV antibiotics for one month, but only if I got a lumbar puncture.

At my two-week check-up, the doctor told me that my treatment would be complete after just one month of IV antibiotics, even though I was still slightly dizzy and exhausted. I decided to seek a second opinion.

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