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James Martin's Lyme Disease Horror Story
How Lyme Disease and Exploitation of ERISA Laws Can Destroy A Life

The only prognosis worse than "poor" (my current prognosis) is "fatal."
Granted Social Security Disability during July, 1999.

Now The Bureaucrats Step In

It turns out, my employee health benefit plan didn't cover home health care (not an eligible expense). So, the doctor discharged me with the strongest oral antibiotics he could prescribe, and said to pray it worked. With the staph infection being in the triangle-of-death, if the staph infection broke the blood-brain barrier, I was dead.

Thankfully, I did recover, and returned to work. While complaining to my manager (Bill Thurlow) about the limited coverage and endangering my life, he commented that I should have called HR, they could have overruled the third party administrator (TPA). Our TPA is First Health (formerly HealthCare COMPARE Corp. and The AFFORDABLE Medical Networks) . This "option" wasn't mentioned in our Summary of Plan Benefits (SPB).

Because of my relapses, the doctor started an alternating treatment plan of IM injections of testosterone and Rocephin. The testosterone was to boost the immune system. Since the staph infection occurred while taking 3 grams daily of oral Trimox, it pointed towards a severely compromised immune system. The IM Rocephin was used to try and raise the antibiotic blood levels (penetrate the Central Nervous System, intercellular walls, and the blood-brain barrier), which the oral antibiotics are incapable of.

This started the first round of benefit plan denials. We even made a complaint to the Texas State Insurance Board. The response from First Health (i.e. "False Hope") was, "we administer an ERISA plan, immune to State regulation, take us to Federal Court to exercise your rights."

To date, the doctor has five figure level of unreimbursed treatment expenses. The TPA used the usual stalling tactics; we need more information to process your claim, documents submitted do not show medical necessity, denied per professional review, etc. As the build-up of denials escalated, we starting doing some tracking. For many of the treatments denied, the doctor provided the requested information up to four times. I even sent "False Hope" a 100% complete copy of the medical record myself.

In June 1998, I came down with another infection at the same site on my nose. "Luckily," this time it was a Herpes Simplex Virus, Type 1 (HSV I) cellulitis infection. However, it was so virulent that IV Gentamicin was added to the other IV antibiotic; the doctor had to prescribe 3 times the "normal" Gentamicin cycle to bring it under control. I was finally discharged (again, earlier than the doctor recommended) to STD on my birthday. Happy 52.

Karen, acting as a patient advocate, sent a letter to HR to try and give them an understanding of what is going on with my health.

I returned to work and received my annual performance appraisal. Although I had provided my company (in the persons of Bill Thurlow, Keanan Wright, John Cole, Lucy Finger, Sherri Hancock, and Linda Farina) with extensive documentation about LD, and the physical and mental manifestations of untreated LD, I was rated "does not meet expectations," which placed me on a 90 day probation. Up until this latest hospitalization, I had always received ratings of "exceeds expectations," even with my interpersonal skills decline. This decline is a "normal" progression of untreated LD; amply documented in the medical literature I had consistently delivered to MRG.