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Blue cross of new york refuses CFS diagnosis and treatment.

Discussion in 'General ME/CFS News' started by wingfield, Jul 16, 2010.

  1. wingfield

    wingfield

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    Blue cross of new york refuses CFS diagnosis and treatment.
    Patients in New York are being refused INSURANCE coverage for diagnosis and treatment, if CFS is considered as the presenting complaint
    Benny
  2. Wonko

    Wonko Senior Member

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    is this a new developement or a standing policy?
  3. Dr. Yes

    Dr. Yes Shame on You

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    Is there an online source for this information, Benny?
  4. xchocoholic

    xchocoholic Senior Member

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    Does this mean that they realize how bogus the diagnosis of CFS is and want people to look for what's really going on ? Even Dysautonomia is a real diagnosis based on the tilt table test. Granted this doesn't tell anyone the real source of what's causing their dysautonomia. Also, whatever the diagnosisis attained by having the test that Pacific Labs is doing would be helpful too. The list of possible real reasons for CFS is a long one. Thyroid, Adrenals insufficiency, LYME, Celiac, nutritional deficiencies, hormones, etc etc ...
  5. usedtobeperkytina

    usedtobeperkytina Senior Member

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    More

    More input, please.

    Tina
  6. Galena1

    Galena1

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    Not specific to this thread (Blue Shield) and I've only skimmed it so far, but it contains a lot of interesting information re attitudes of many insurance companies to ME/CFS and how they will try to avoid paying out and are clearly doing their best to 'stack the cards' against sufferers. Weasselly figures in it.

    http://www.meactionuk.org.uk/Notes_on_the_Insurance_issue_in_ME.htm
  7. zoe.a.m.

    zoe.a.m. Senior Member

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    How, precisely, does an insurance company flat-out deny treatment/diagnosis for an illness that has a CDC webpage? I realize that the ins. companies can do much to avoid paying because of the exceptionally crummy nature of the diagnosis and how much of the treatment requires care such as supplements, special lab testing, etc. and I know that the CDC is a ship of fools, but still...

    This is a good opportunity to fight for the legitimacy of ME/CFS, and begs to get the name away from CFS--wonder if anyone could make a case that treatment is being denied because of the name alone?

    I don't know enough about the infrastructure to take a good guess at how the CDC's identification of an illness might require that it be recognized and treated, but something really stinks here, more than usual...!
  8. usedtobeperkytina

    usedtobeperkytina Senior Member

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    wingfield, we need more information to understand what this is about or express our opinions or take action.

    Tina
  9. kess3881

    kess3881

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    I am aware that Dr. Enlander's patients in NYC are being denied treatment coverage by Blue Cross, beginning a week or two ago.
  10. muffin

    muffin Senior Member

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    After we verify that BC/BS of NY is discriminating against CFIDS people, we look to see what other insurance companies are playing games with us - here in the US, Canada and UK (http://www.meactionuk.org.uk/Notes_o...ssue_in_ME.htm). We have to verify that they are playing games with us and then we go after them - big time. We need to expose them in the media and to Congress, the White house,etc. Now is so not the time for them to be playing games with the pressure of Health Care Reform going on. This Reform plays to our favor.

    Have to find out what organization is in charge of the US Health insurance Industry. There must be some org providing oversight, etc. We need to get to them and tell them what BC/NY is doing as well as others who are playing this game, prob. in anticipation of the XMRV studies release, but also going way back to the begining when you could not get LTD (still a problem). Also need to get the list of those playing games in the UK (as provided in the link above).

    Now, I'm very tired but it seems to me that we kill two birds with one stone here. First, we go after the insurance companies for not covering us for health and disability. Enough of this BS game that they have played for 30 years. I too was turned down for LTD and had to take leave-without-pay -- very kind of the company that I killed myself for for 10 years.

    Second, I think this may be the way to get to the UK morons making money off being consults at the insurance companies - White, Sharpe, Weasel, etc. That information needs to be made public big time. Very big conflict of interest as we all know but apparently the UK government doesn't seem to know. Can't have this conflict of interest, can we? IF we get to the insurance companies in the UK that are using these sociopaths as consults to deny benefits to the CFIDS/ME sick, we work backwards to getting at these guys and taking them out of their lofty positions. We are essentially working backwards to get rid of the UK sociopaths. So again, have to get to the media and the government about their involvement in private industry as public servants, etc. NOTE: If the UK people are worried about being "found out", PM me with your letters and I will sign my own name and email them off to where you want them to go. You know I can't sign with an American address, but we will find a way around that one.

    Have to go verify that BC/NY is doing this type of discrimination and see who all else is also playing this game.

    We have so many wars on so many fronts to fight. But, we have a lot of super smart people who can think, write well, and will beat upon those people and companies/industries that must be beaten upon. We also have our journalists!!!! These guys can hit the media beter than me. So, we get people like Tina to hit the media with her well-written words.

    First, we have to verify all of this info.
    Sorry, so tired from that LENS stuff. Still in a sleep stage and not coming out of it.
  11. usedtobeperkytina

    usedtobeperkytina Senior Member

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    Me?

    Tina

    (and I am typing this because it says my message above is too short to be posted)
  12. muffin

    muffin Senior Member

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    Yes tina - you!

    Tina: You and the others from the journalist side of the house can write well and you know it. So, we use people like YOU and others who are great writers to hit the media. I am sure that all of you have been doing this all along, but now we need the very best writers to go at it.

    My brain was qute damaged from 16 years of CFIDS. Now, with the Low Energy Neurofeedback I really can NOT think or write and I do not want to write blather and mess it up for all of us. That means that the smart people who write well have to be the front line in this battle.

    I will try to hunt down info on what the heck is going on with BC/NY and other insurance companies, in addition to the games played on the UK ME folks, but you need to do your special thing and write so that it is intelligent and clear. Don't need a major potty mouth like me writing, do we? Didn't think so!
    Though i think I should be commended for not dropping the F-bomb even once. Not even once!!!
  13. Galena1

    Galena1

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    In my opinion, the UK government do know but are content to go with the flow, any flow, to reduce the massive benefit payments bill, for now at least. The clearly biased medical assessments, despite the nuerous complaints of how they are implemented, and the government's enthusiasm to continue with them in their current format, speaks volumes.
  14. Otis

    Otis SeƱor Mumbler

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    Would love more details so we can publicize.

    Maybe the NYT would help or pick up the story if we can get it spread across the internet.
  15. Anika

    Anika Senior Member

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    There are some things we need to know to understand this better.

    Does this represent a change, where a patient who previously had the same treatments covered, was suddently refused coverage for the treatment? Also, do we know that it wasn't an error with a new billing code person at the doctor's office, for example, using a different code than they had used before?

    Denial of coverage usually happens in CFS and some other illnesses when a test or treatment is considered "experimental" or not supported by the weight of medical evidence. There is usually a coverage bulletin that the insurance company has to support / defend its policy. I think I've seen one from Aetna posted somewhere before, for example. Denial of coverage can be appealed. Sometimes, a different diagnosis can be used to support the same treatment.

    At least as of a few years ago, I think quite a few insurance companies provided minimal coverage for testing / treatments for CFS. It does not help that the CDC continues to say, there are no diagnostic tests and there are no treatments (and I think it even says they shouldn't be done, except as indicated to rule out other diagnoses). Some insurance companies are worse than others in terms of their policies. That is why it is so important to know if there was a sudden change in BCNY policy here, or in how they applied the policy.

    Typically, many of the tests covered for CFS patients, for example, are done to exclude other conditions - such as mono, cardiac, neuro, etc. So they aren't covered as CFS tests, but for some other possible illness / diagnosis that might be there or get ruled out.

    I am a layman, not someone with insurance company or billing expertise, but I do recall this issue coming up several years ago on the ProHealth board, when there was an issue with coverage for one of the tests I had. Most CFS doctors have probably encountered issues with different insurance companies along the way, and know what is usually covered or not.

    This is an important issue. Thanks for bringing it to our attention.
  16. muffin

    muffin Senior Member

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    Good points Annika. We need far more info on the BC/NY situation before we go off screaming and yelling. Much more info.
  17. muffin

    muffin Senior Member

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    Insurance Info on CFIDS from a Disability Attorney (MetLife, Aetna, UNUM Provident)

    MetLife denies chronic fatigue syndrome long term disability claim
    http://www.diattorney.com/metlife-denies-chronic-fatigue-syndrome-long-term-disability-claim/

    Without disability attorney chronic fatigue sufferer would be denied rightful benefits
    Magee v. MetLife is another disability case that highlights the importance of hiring a disability insurance attorney when you have been denied disability benefits for chronic fatigue syndrome (CFS). It is far too common for disability insurance plans to use the lack of objective proof as a reason for denying the existence of a truly limiting disability.

    John Magee, who was 49 years old in 2009 when the Court considered MetLifes denial of Magees long-term disability benefits, was diagnosed with CFS. He had worked as a quality engineer in Eastman Kodaks Government Services division, participating in Kodaks Long-Term Disability Plan. Metropolitan Life Insurance Company (MetLife) administered the plan and had full discretionary authority to determine Magees eligibility and to award him benefits.

    Typical of most disability insurance plans The Kodak LTD Plan defined disabled as a condition in which Magee was totally and continually unable to engage in gainful work. Gainful work by plan definition was paid employment for which Magee was or could become reasonably qualified by education, training, or experience, as determined by MetLife. The plan also included another typical featurethe requirement that Magee apply for Social Security Disability Income benefits (SSDI). If SSDI benefits were awarded, Magee would have an obligation to refund the Plan for the overpayment of benefits. Thereafter, the monthly benefit payment received from the Plan would be reduced by the monthly Social Security disability payment.

    Magee filed his claim with MetLife on July 24, 2004. His attending physician, Dr. David Bell, submitted an Attending Physicians Statement of Functional Capacity Evaluation (FCE) on September 1, 2004. In the FCE, Dr. Bell listed his primary diagnosis as CFS with a secondary diagnosis of depression. Dr. Bell reported that Magees CFS severely limited his ability to walk, stand, and assume a cramped position, reach, climb, balance, bend, and give concentrated visual attention.

    On September 20, 2004, MetLife conditionally awarded disability benefits through December 20, 2004, telling Magee that while the medical records supported the severity of his condition, the disability insurance plan questioned the lack of clear objective findings. MetLife went on to conduct an investigation into Magees mental condition.

    MetLife contacted Magees psychiatrist, Dr. Alice Tariot, and his counselor, Carolyn Cerame in October 2004. Dr. Tariot released her opinion on November 1, 2004 that Magee was suffering from major depression and CFS. She also stated that Magees negative outlook was tied to coping with the seriousness of his illness and resultant loss of function.

    MetLife sent Magees file to two consultants for evaluation. Dr. Amy Hopkins, who specializes in internal and occupational medicine, concluded that Magees diagnosis was primarily based on a variety of self-reported [symptoms] with no objective support by examinations or diagnostic test results. Dr. Hopkins pointed to the lack of objective support for the presence of a condition so severe as to prevent Magee from performing the material duties of his own or any occupation on a full-time basis. She saw no need for the restrictions or limitations Dr. Bell had placed on his patient.
    Dr. Bell responded to this report, stating that Magee met the criteria released by the Centers for Disease Control (CDC) for CFS. He suggested that if MetLife questioned the functional ability of his patient that MetLife conduct a comprehensive work and function evaluation and an exercise physiology test. Dr. Bell suggested the exercise physiology test be conducted on two consecutive days. He expected it to show marked impairment in Magees aerobic capacity and suggested that this might help to document Magees disability. MetLife did not respond to this suggestion.

    Dr. Ernest Gosline, a psychiatrist, was the second physician MetLife hired to look at Magees file. This doctor agreed that CFS was Magees primary condition, but that his secondary depression was a disabling impairment that prevented him from working. Unlike Dr. Bell, Dr. Gosline found that Magees medical record substantiated his impairments both through objective clinical findings and self-reported information.

    MetLife approved Magees claim on December 18, 2004 based on Dr. Goslines opinion. The approval letter failed to explain the basis for why MetLife was agreeing to pay disability benefits, while MetLifes internal records stated that the [d]ocumentation is limited for the Chronic Fatigue Syndrome. This would become a problem for Magee.

    MetLife re-evaluates qualifications for disability benefits
    In June 2005, MetLife asked Dr. Bell to provide an update on Magees condition. In addition to telling the disability insurance plan administrator that Magees CFS symptoms were still very severe, he sent the results from three questionnaires that have become standard in CFS diagnostic evaluations.
    1. A Krupp fatigue score of 56clearly in the disabled range.
    2. A modified Karnofsky score of twenty-five percentalso clearly in the disabled range.
    3. An SF-36 questionnairean extremely validated indicator of overall disability which showed marked disability. The SF-36 questionnaire showed normal emotional functioning which suggested that his disability was physical not mental.
    The tests had been given four timesin May 2004, July 2004, December 2005, and February 2006. Each time the results had been the same.

    MetLife requested information from therapist Carame in February 2006. She responded that she had only seen him once in the past year, but that in her 20 years of practice she had never had a client who made a more heroic effort. She noted that his pain was excruciating.
    Dr. Bell sent MetLife another Chronic Fatigue Initial Function Assessment in which he once again repeated his opinion that Magee still had marked disability. In April 2006, MetLife asked for Dr. Tariots assessment of Magees mental status. She reported that his mood was stable and that he was now coping more effectively with his CFS.

    Social Security determines that CFS is completely disabling
    Around this same time, March 2006, Magees application for Social Security disability benefits was approved. The Administrative Law Judge (ALJ) found that the evidence supported several medically determinable severe impairments: fibromyalgia, chronic fatigue syndrome, orthostatic hypotension, hypovolumia, and an affective disorder. The ALJ observed that psychiatrist Dr. Tariot was in agreement with Dr. Bell when he found that Magees depression was secondary to his physical pain and illness. Finding that Magees claims were consistent with the medical findings and were supported by the opinions of the examining and treating physicians, the ALJ found Magee completely disabled. He concluded that Magee lacked the residual capacity to perform even sedentary work.
    MetLife then requested Magee produce the Plan mandated reimbursement for overpayment of long-term disability benefits. The amount demanded? $51,886.27. Magee was able to reimburse MetLife all but $16,831.21 of the amount.

    MetLife finds that mental health no longer basis for continuing disability benefit paymentsbegins questioning CFS as basis for continuing benefits

    MetLife reviewed Dr. Tariots report of April 2006 and determined that Magees depression was no longer severe enough to be disabling. So the disability insurance plan sent his file to another independent physician consultant, Dr. Dennis Payne, a rheumatologist, to determine whether his CFS was disabling.

    Dr. Payne observed that Magees evaluations by his physicians have been extensive and appropriate. After conferring with Dr. Bell, who acknowledged that there were no objective findings of joint or muscle damage or any identifiable objective musculoskeletal problem(s), Dr. Payne gave MetLife his opinion. [T]he objective medical record presently supports that Mr. Magee is capable of performing unrestricted work duties , and that there are no restrictions or limitations that are supported in the available medical data. He went on to render his opinion that Magees CFS diagnosis was based entirely upon subjective symptomatology without any objective findings on examination, laboratory testing, imaging data, or other specific objective studies to evaluate conventional disease.

    Dr. Bell disagreed with Dr. Paynes conclusions that Magee was capable of performing unrestricted work duties. Dr. Payne conceded that CFS has been given the designation of a syndrome (constellation of symptoms) which has no histopathological correlates so the lack of clinical evidence would be expected with the stated diagnosis. Yet, Dr. Payne refused to alter his conclusions. He stated that even with a syndrome, as with a well defined illness or disease, there must be objective measures that support functional restrictions or limitations before limitations can be placed on an individual.

    MetLife terminates disability benefits due to lack of clinical evidence for the second time
    On July 20, 2006, MetLife notified Magee that after conducting a thorough review of his file, MetLife was going to terminate his long-term disability benefits. Dr. Paynes conclusions were clearly the reason for the decision, for his findings and conclusions were cited in the termination letter. Magee was told that the lack of clinical evidence to support the existence of a totally disabling condition preventing you from performing your occupation you are qualified for based on your education, training or experience (such as office visit notes and physical exam findings that supported an ongoing severity of impairment) was the reason for the denial.

    MetLife ignores request for definition of objective evidence

    In December 2006, Magee asked MetLife to provide a definition of what would constitute sufficient objective evidence to confirm [his] diagnosis of Chronic Fatigue Syndrome and the functional impairment that leads to my disability because he had not been able to find during the four months since MetLife terminated his benefits any objective diagnostic test that is suggested for confirming his disability. MetLife never responded.

    Magee then filed an appeal with MetLife in March 2007. His appeal pointed to orthostatic hypotension and blood volume tests in his file which he claimed Dr. Hopkins had overlooked. He also stated that it appeared that Dr. Payne had also ignored the blood volume testing and orthostatic hypotension test, as well as Krupp Fatigue Severity Scale test, SF-36 Short Form Health Status, and Modified Karnofsky testing. He argued that the requirement to provide objective indications of CFS was unreasonable, and pointed to the numerous errors in MetLifes documentation.

    On March 8, 2007, Dr. Bell presented MetLife with additional documentation in support of Magees appeal. This included:
    1. Further clarification on what the blood volume test results showedthat Magee was suffering from idiopathic hypovolumia.
    2. Results from a February 6, 2007 MRI brain scan showing abnormal non-specific periventricular hyperintense white signals
    3. The results of a March 6-7, 2007 exercise test which demonstrated despite excellent effort that Magees oxygen uptake was much lower than that of a normal person
    4. Lab results showing low rennin levels in Magees blood.
    Dr. Bell referred MetLife to published studies that have identified each of these results as potential markers for CFS. He took the time to carefully explain the diagnostic criteria he had applied, the basis for those criteria, and his experience in diagnosing and treating CFS. He concluded by stating that he saw no evidence that Magees symptoms were caused by depression.
    MetLife sent Magees file to Dr. Joel Maslow, an infectious disease specialist. On March 22, 2007, he reached the same conclusion as Dr. PayneMagee was not disabled. In Dr. Maslows opinion, because Magees claims of pain and cognitive dysfunction were not supported by objective findings from physical examination or neuro-psychiatric testing, and the objective evidence showed normal musculoskeletal function and no cognitive dysfunction supported his symptoms, Magee was functional.
    Dr.Maslow questioned Dr. Bells experience with delivering and interpreting the SF-36 test and claimed that it could not be interpreted in isolation. He stated that the blood volume tests were also isolated and failed to present clear symptoms of orthostatis. One of the blood volume tests mistakenly referred to Magee as a female, so Dr. Maslow threw out the results from this test completely. He also claimed that the orthostatic hypotension measurements were inconsistent and too few to have any value.

    Despite the fact that Dr. Maslow admitted that CFS fell outside of his expertise, he issued his conclusion that Magees symptoms were the result of depression rather than CFS, because depression had not been clearly excluded as a cause for his symptoms. He did not indicate in his opinion whether he had considered the two-day exercise test, the MRI scan, or the abnormal rennin levels when he stated that from an infectious disease perspective, Mr. Magee does not meet the criteria for this syndrome.

    Dr. Bell responded on April 13, 2007 to Dr. Maslows report. He submitted a copy of his Curriculum Vitae to MetLife. MetLife should have noted the following facts:
    Dr. Bell had advised and chaired CFS committees at the U.S. Department of Health and Human Services and the National Institutes of Health.
    Dr. Bell had been the primary lecturer at more than eighty CFS conferences.
    Dr. Bell had been invited to write over 13 reviews about CFS, including several on how to diagnose CFS.
    Dr. Bell had authored thirteen published papers and five books about CFS including the book, The Doctors Guide to Chronic Fatigue Syndrome, published in 1994.
    Dr. Bell was clearly one the best physicians that Magee could have chosen for his primary care provider.

    Despite this information, MetLife denied Magees appeal on May 7, 2007. The denial was first based on Dr. Bells opinion that Magee no longer suffered from disabling depression and the fact that Magee was no longer seeing a mental health professional. MetLife deemed Magee no longer disabled from depression. MetLife went on to determine that though he had some medical conditions, the disability insurance company did not find that they would keep him from working in his own occupation.
    MetLife pointed specifically to the lack of medical evidence from clinical findings to support the severity of Magees claimed functional limitations. MetLife informed Magee that when his file was reviewed from an infectious disease perspective, he failed to meet the criteria for chronic fatigue syndrome. The disability insurance company claimed that his health care providers had failed to substantiate his disability with comprehensive and specific information.
    Magee had no choice. If he was to receive his rightful benefits for long-term disability, he would have to take action in the U.S. District Courts Southern District of New York. His disability attorney would be a very important part of successfully proving that MetLife had abused its discretion when it denied his claim. We will discuss how the Court reviewed Magees claim in the article: New York court rules that MetLife abused discretion when it denied chronic fatigue claim (Part II).
    About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell shares these court cases so you can understand how complex representing disability insurance claimants actually is. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. For a free consultation, please call 800-828-7583 or use our contact page.
    SIMILAR CASES:
    MetLife denies chronic fatigue syndrome long term disability claim
    MetLife abused its discretion when it terminated long-term disability benefits
    Court orders Prudential to re-evaluate long-term disability claim of engineer suffering from chronic fatigue syndrome and fibromyalgia
    Truck driver denied disability benefits for chronic fatigue syndrome by Aetna
    Disability attorney wins claim for Chronic Fatigue Syndrome client against Unum Provident (Part II) Unum Provident denies short-term disability claim to woman with chronic fatigue syndrome (Part I)

    -------------------------------------------------------------------------------------
    About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. For a free consultation, please call 800-828-7583 or use our contact page.
  18. usedtobeperkytina

    usedtobeperkytina Senior Member

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    Ironic, so if you have depression, you are approved. But if you have CFS, you aren't.

    What, pray tell, is the objective test for depression?

    While this report is interesting, it goes to disability denial. We know we have that. (And by the way, people with other diseases often have to get attorneys to prove disability.) But what about the issue in the original post.

    Still need more details.

    Tina
  19. Anika

    Anika Senior Member

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    Tina, you're right, health insurance issues are the primary topic on this thread. And, still need more details!

    While we're waiting.... From a health insurance standpoint, I think we'd be better off if the CDC stopped saying, in effect, "no tests, no treatments" for CFS. There is not "a single" recognized diagnostic test for CFS, but many immune and neurological diagnoses don't have a single diagnostic test, either. (And some patients with those conditions get diagnosed early on with CFS just because there aren't earlier diagnostic tests for those conditions, if I understand Dr. Lucinda Bateman's comments correctly.) Even infectious diseases like HIV sometimes require multiple types of tests to confirm or disprove the tentative diagnosis.

    We are sort of in a Catch-22 position when it comes to testing and diagnosis. CDC says: we don't need no stinking testing or treatment (for CFS). Then, does the health insurance company also say no testing, no treatment? Then, the disability insurance company (and Social Security to a lesser extent), says: No testing? No benefits.

    Insurance coverage, both health and disability, is an important reason why we need good published studies on CFS, both testing and treatment trials - and using meaningful research criteria. Tests or treatments that are supported by research are more likely to be recognized by insurance companies.

    Thoughts???
  20. Dr. Yes

    Dr. Yes Shame on You

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    That is one of the Superpowers conferred to the psychiatric profession. 'Objectivity' in psychiatric/psychological parlance means as little as the subjective clinical observation of a patient for 'signs' of depression, which are taken to carry more weight than the patient's own interpretation, of course. The most it means is a 'psychometric' test like the MMPI which is so flawed it's (almost) hilarious. In contrast, 'objective evidence' for a physical disease can, especially from insurance companies, include demands for PCR evidence (which they won't pay for), medical 'consensus', and 'proven' causality (good luck!). The imbalance of expectations here is staggering.

    The last time I checked Aetna's policy on CFS testing reimbursement, I was pretty shocked: they were on top of all the latest research and how it pertained to testing -- in order to specifically deny coverage of a number of tests we are all familiar with - notably RNAse L tests and SPECT or PET scans. For each one they would state something like 'these findings have not been widely confirmed', or would cite a single negative study to counter the other findings, or would make a blanket state that such-and-such test has yet to be proven to have clinical significance "in CFS".

    Definitely, more studies are necessary, and therefore more funding, but the problem remains that we are up against corporations/ governments that simply don't want to have to pay if they can find enough doctors to give them a 'sufficiently' negative consensus. I expect that they will keep moving the goal posts even if more positive findings come out. One reason I was so hopeful (and still have my fingers crossed) about the Alter study is that, coming from the FDA and NIH, it would potentially be harder to dismiss by insurance companies that are good at ignoring the findings of independent researchers... and of course if a pathogen like XMRV is associated with abnormalities in RNAse L or perhaps in cerebral blood flow, it might become easier to pressure these companies to reimburse such testing.

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