Kaiser reimbursement of HBOT

[Guest guest]

>Hi,

>

> Okay, so Kaiser paid for a stroke victim. What would I do to get them to

>pay for me, an adult with CP? I asked a couple of Kaiser doctors to give

>me a Rx for HBOT. They absolutely refused to have anything to do with it.

>However, one was willing to send me for the x-rays part.

>

> I tried to get them to pay for a tricycle for me. They refused. They said

>they didn't provide that kind of DME. A friend of mine who has a child

>with really severe issues went through the whole system at Kaiser for the

>same thing and was refused as well. I had a prescription written for it by

>my doctor in their system and it was refused. They also refused to do EEG

>biofeedback or reimburse me for it. They use it " only as a last resort for

>pain when surgery, all the meds in world don't work, " then they'll

>consider biofeedback for a patient. Pretty ridiculous when it works and

>would save them money in the long term.

>

> I won't tell you what other things they have refused to help me with. I

>am only on the plan because of " preexisting conditions. " Believe me, I'd

>go elsewhere if I'd get decent coverage but with those kind of laws in

>place, no one gets the help they need when they have special needs as an

>adult.

>

> Dina

>

Dina,

First, thanks for joining the listserv.

Second, as you pursue reimbursement for the off-label use of hyperbaric

oxygen, think of this as building a case.

Start with this. Go back and look at everything Kaiser has paid for in the

past--drugs, treatments, therapies, etc.--pull all your documentation of

where they have paid for wahatever you've received and see how much has

been FDA-approved for your diagnosis.

Almost everything for cp has never been " proven " effective by the gold

standard of evidence-based medicine: the double-blind controlled study.

Almost everything is also prescribed off-label.

Gather your documentation of this because the " the standard of medical

practice " for cp is the off-label use of whatever.

This means when you're seeking reimbursement for off-label you're asking

for something that's consistent with the the standard of medical practice

for cp.

Next, gather evidence where Kaiser has paid for the off-label use of HBOT

for brain-injury--some of which can be downloaded from

medicaid/files/ :

1. Kaiser and Blue Cross/Blue Shield jointly reviewed the literature on

HBOT for brain-injury. The official Blue Cross/Blue Shield policy that

resulted from this is on

medicaid/files/ . Here Kaiser/BC/BS

admit that the " scientific " evidence to support the reimbursement of the 13

approved indications only exists for four of those indications. Further,

Kaiser/BC/BS admit much of their reimbursement policy comes from the The

Undersea and Hyperbaric Medical Society (UHMS).

2. The Undersea and Hyperbaric Medical Society (UHMS) also admits the

" scientific evidence " only exists for 4 indications--and declares in their

Ethics Committee report that adding indications is an arbitrary process.

They also admit it's nearly impossible and thus risky to perform a

double-blind controlled study of HBOT for cp. This documentation is found

at HDO-documentation/files/ .

3. If you go to http://www.uhms.org and pull up " By-Laws " , you'll see that

the Undersea and Hyperbaric Medical Society has no authority to decide what

or what not HBOT can be used for.

4. According to the Americans with Disabilities Act, medical treatments

cannot be withheld based on either diagnosis or age. I don't have that

documentation but maybe somebody here does.

5. Kaiser has paid for off-label use of HBOT for stroke. This documentation

is at medicaid/files/ .

6. When you subscribed to the listserv you should have

automatically received a pdf of where Colorado Medicaid has been ordered to

reimburse HBOT for . is 20 years old and will be 21 in

May. Kaiser held the contract to administer the Medicaid program in

Colorado and has been ordered to reimburse the s.

lso admits in paid for off-label

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