Home / Health / Tick Bite Leads to Insurance Denial Nightmare for Maine Woman
Tick Bite Leads to Insurance Denial Nightmare for Maine Woman
16 Nov
Summary
- Leah Kovitch's insurer denied coverage for her walk-in clinic visit after a tick bite
- Clinic found a second tick and confirmed Lyme disease, but insurer refused to pay
- Kovitch had to appeal the denial and eventually received a full refund
In late April 2025, Leah Kovitch, a resident of Brunswick, Maine, discovered a tick on her leg after spending time in her local meadow. By Monday, her calf muscle had become sore, prompting her to seek medical attention. Kovitch first consulted a telehealth doctor recommended by her insurance plan, who prescribed a 10-day course of doxycycline and advised her to see a doctor in person.
Later that day, Kovitch visited a nearby walk-in clinic, where staff found a second tick on her body and confirmed that one of the ticks had tested positive for Lyme disease. Clinicians then prescribed a stronger, single dose of the medication. Kovitch said the prompt treatment likely prevented her from becoming "really ill."
However, Kovitch's insurer, Anthem, denied coverage for the walk-in visit, citing a lack of prior authorization. Kovitch attempted to appeal the decision, even obtaining a retroactive referral from her primary care doctor, but her efforts were unsuccessful. It was not until KFF Health News contacted Anthem that the company acknowledged a "billing error" and agreed to cover the entire $238 cost of the appointment.
The incident highlights the ongoing challenges patients face when navigating the prior authorization process, even for seemingly routine and medically necessary care. While insurers argue that such policies help reduce waste and fraud, Kovitch's case demonstrates how they can create unnecessary obstacles for patients seeking timely treatment.
