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Volume: 3
Issue: 03
Date: 01-Mar-95

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
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


*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *

IDX#                Volume 3 - Number 03 - 3/1/95
IDX#                            INDEX
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

I.    LYMENET: National LymeNet Technical Notes
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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

[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
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

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
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

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.


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