Volume: 3 Table of Contents: I. LYMENET: National LymeNet Technical Notes II. LYMENET: New Jersey Medical Insurance III. DEL MED J: The epidemiology of Lyme disease in Delaware 1989-1992 IV. RES MICROBIOL: Evidence for the involvement of different genospecies of Borrelia in the clinical outcome of Lyme disease in Belgium V. About The LymeNet Newsletter Newsletter: *********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * *********************************************************************** IDX# Volume 3 - Number 03 - 3/1/95 IDX# INDEX IDX# IDX# I. LYMENET: National LymeNet Technical Notes IDX# II. LYMENET: New Jersey Medical Insurance IDX# III. DEL MED J: The epidemiology of Lyme disease in Delaware IDX# 1989-1992 IDX# IV. RES MICROBIOL: Evidence for the involvement of different IDX# genospecies of Borrelia in the clinical outcome of Lyme IDX# disease in Belgium IDX# V. About The LymeNet Newsletter IDX# I. LYMENET: National LymeNet Technical Notes ----------------------------------------------- Sender: Marc Gabriel <[email protected]> Please note that the National LymeNet service (in the lymenet.org Internet domain) does *not* offer anonymous FTP access to information. As many as 100 attempts are made each week to access information via FTP from lyme.lymenet.org . Please use the gopher system to obtain public LymeNet documents. The gopher server can be reached at gopher.lymenet.org . America Online users should be aware that AOL has imposed a restriction on the size of documents that may be downloaded from Internet gopher servers. As such, large documents are truncated. We have received many complaints from AOL users who have attempted to download materials from our gopher server, but there is little we can do at this time. We suggest that subscribers contact the AOL helpdesk to request that the limit be removed. =====*===== II. LYMENET: New Jersey Medical Insurance ------------------------------------------- Sender: Susan Dawson <[email protected]> In 1992 the New Jersey legislature passed (Public Law) P. L. 1992, Chapters 161-3: [1] effective November 1993, intending to: 1) Make medical insurance available to as many citizens as possible, 2) Create a consumer favorable situation for the marketing of medical insurance, and 3) Have all medical insurance fall under state regulation. These laws divide the medically uninsured citizens into two groups: those who buy insurance as individuals (including heads of households buying coverage for the family) and those working for small businesses with two or more employees. [2] The laws state that any insurance entity selling medical insurance in the state must sell standard health benefit packages to these two groups on an open enrollment, community rated basis. For those with pre-existing medical conditions the insurance plans have a one year waiting period but coverage cannot be denied. If a person with a pre-existing condition has had continuous coverage with any medical insurance for at least one year immediately prior to being covered by these plans, the waiting period is waived. The new coverage must begin within 30 days of the termination of the previous coverage. [3] These medical insurance plans are standardized to make price comparison manageable. The state offers a Buyer's Guide, along with a current list of all insurers and the prices that they charge, free to those calling (800) 838-0935. [4] The Buyers' Guide provides a description of the plans: five fee-for-service plans and one health \ maintenance organization plan. Insurers can charge what they want for the plans within certain restrictions. First, the price must be the same for everyone purchasing the package (community rating) and second, the insurer must pay out in medical claims at least $0.75 out of every premium dollar collected. Just because the plans are standardized does not mean that they are identical. Before purchasing a plan obtain "specimen" contracts from each company for each plan. Because they are written from the same template the differences are easy to spot when the contracts are laid side by side. [5] The differences are subtle, interesting and noteworthy. Consider them carefully. Our decision took three months. I started by deciding which plans offered the best coverage considering our Lyme. I made a spreadsheet which took our total medical bills for the last three years and applied the various deductibles and coinsurances. That told me which plan was best, economically. Next, I chose the five companies charging the least amount for our choice. I plugged the premiums for one year into my spreadsheet to figure out which deductible level was best. Then I called each company and asked for a specimen contract using the contact information provided by the state. [6] While I was waiting for the specimens to arrive, I contacted the business manager for each of our medical providers. I told them which companies I was considering and asked which, in their experience, was easiest to deal with. [7] That left three companies. My husband and I read the specimen contracts using post-it notes marked plus or minus to highlight differences for the final elimination. In the last six months our medical claims have been consistently paid in 30 days. I have only had to resubmit three claims and I had only one bill discounted ($20) for exceeding "reasonable and customary" charges. I have not written my new insurance company and I haven't considered writing a regulator. [8] Further, not one provider has grimaced when I presented my insurance card! The first year for these laws has now passed and the number crunchers have been busy. The premium changes have been staggering (-30% to +120%). But for me at least, even with higher premiums, the costs are only now approaching what I was paying before for erratic coverage. ________________________ [1] When asked to consider, comply with, support or act on a bill, it is a good idea to read it first. New Jersey maintains the Legislative Information Service (800) 792-8630 which provides citizens with copies of bills as well as answering questions about the status of bills, legislative procedures and legislative calendars from 9:30 to 4:30 whenever the legislature is in session. [2] The self-employed with no employees are considered to be individuals. [3] I was required to provide a copy of my current contract with a starting date or a copy of my canceled check for the initial payment and the most recent bill. [4] Allow a couple of weeks, and several phone calls, to get the Buyer's Guide. [5] Insurance companies are required to provide specimen contracts on request but usually resist doing so. It takes persistent insistence (and several weeks) to get a specimen. Be prepared to be told you aren't capable of reading or understanding a contract. (If you can't understand it, you should not buy it.) Be wary of any company that won't provide a specimen contract. [6] The contact information from the state seems to be a list of corporate or regional offices. They are not expecting customers to call but they will put you in contact with a local broker. [7] Remember that liability laws skew what can be said when making a recommendation. To prevent putting anyone in a bind, concentrate on asking for positive information and let the negative information come from silence. [8] New Jersey Department of Insurance commissioner Drew Karpinski says that there are two controlling bodies: New Jersey Small Employer Health Excess Insurance Program Board at 102 West State Street, Trenton NJ 08608-1102 (609) 989-9794 and New Jersey Individual Health Coverage Program Board at 106 West State Street, Trenton NJ 08608 (908) 632-7408. If they don't help, try your state representatives. =====*===== III. DEL MED J: The epidemiology of Lyme disease in Delaware 1989-1992 ------------------------------------------------------------- AUTHORS: Wolfe D, Fries C, Reynolds K, Hathcock L ORGANIZATION: Delaware Division of Public Health, Dover REFERENCE: Del Med J 1994 Nov;66(11):603-6, 609-13 ABSTRACT: OBJECTIVES: The study was conducted to describe the temporal, geographic, demographic and treatment characteristics of Lyme disease in Delaware and to assist health planners in developing and implementing control strategies. METHODS: All physician-submitted Centers for Disease Control and Prevention (CDC) follow-up Lyme disease report forms from 1989 through 1992 were reviewed for completeness. Data were gathered from completed forms only. All cases were classified according to the 1990 CDC surveillance case definition. Cases were further subdivided into two groups. Antibiotic usage patterns were then identified for each group. Data on the percentage of infected ticks by county were obtained from a 1988 study conducted by the University of Delaware; Delaware Health and Social Services, Division of Public Health; and the Department of Natural Resources and Environmental Control. RESULTS: Reported cases of Lyme disease increased 246 percent between 1989 and 1992. The 1992 statewide incidence rate was 12.6 cases per 100,000 population. Whites were four times more likely to contract Lyme disease than were blacks. The majority of cases were reported between June and October. The number of patients being treated with oral antibiotics for localized disease for three weeks or longer increased from 52 percent in 1991 to 94 percent in 1992. Ixodid ticks infected with Borrelia burgdorferi were found in all three counties. CONCLUSION: The Delaware State Board of Health made Lyme disease reportable in September 1989. This requirement increased the quality of Lyme disease surveillance; however, the disease is probably under-reported since Delaware does not actively solicit Lyme disease reports. Delaware's case data reflect national data which indicate an increase in reported cases. A trend toward longer duration of treatment for localized Lyme disease is evident. =====*===== IV. RES MICROBIOL: Evidence for the involvement of different genospecies of Borrelia in the clinical outcome of Lyme disease in Belgium -------------------------------------------------------------- AUTHORS: Anthonissen FM, De Kesel M, Hoet PP, Bigaignon GH ORGANIZATION: Laboratoire de Serologie bacterienne et parasitaire, Cliniques Universitaires Saint Luc, Brussels ABSTRACT: In addition to Borrelia burgdorferi, recognized as the aetiological agent of Lyme disease, at least two separate genospecies have recently been described. A relationship between infection by strains belonging to different genospecies and clinical outcome has been suspected. In this paper, 9 cases of Lyme arthritis were attributed to infection by B. burgdorferi sensu stricto, 18 cases of neuroborreliosis to B. garinii and one case of acrodermatitis chronica atrophicans to a strain of B. afzelii. These conclusions were based on the preferential reactivity of sera with antigens of given strains in Western blots and on residual reactivity after absorption of sera with antigens of representative strains. No conclusion could be reached concerning sera of 10 patients with erythema migrans. =====*===== V. ABOUT THE LYMENET NEWSLETTER ----------------------------------- For the most current information on LymeNet subscriptions, contributions, and other sources of information on Lyme disease, please request the LymeNet Resource Guide. To obtain the Guide, send a blank message to: [email protected] ----------------------------------------------------------------------- The LymeNet Resource Guide is in Revision: 1.10 ----------------------------------------------------------------------- LymeNet - The Internet Lyme Disease Information Source ----------------------------------------------------------------------- Editor-in-Chief: Marc C. Gabriel <[email protected]> FAX: 908-789-0028 Contributing Editors: Carl Brenner <[email protected]> John Setel O'Donnell <[email protected]> Frank Demarest <[email protected]> Advisors: Carol-Jane Stolow, Director <[email protected]> William S. Stolow, President <[email protected]> The Lyme Disease Network of New Jersey (908-390-5027) ----------------------------------------------------------------------- WHEN COMMENTS ARE PRESENTED WITH AN ATTRIBUTION, THEY DO NOT NECESSARILY REPRESENT THE OPINIONS/ANALYSES OF THE EDITORS. ----------------------------------------------------------------------- THIS NEWSLETTER MAY BE REPRODUCED AND/OR POSTED ON BULLETIN BOARDS FREELY AS LONG AS IT IS NOT MODIFIED OR ABRIDGED IN ANY WAY. ----------------------------------------------------------------------- SEND ALL BUG REPORTS TO [email protected] ----------------------------------------------------------------------- |
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