Re: [MedicaidforHDOT] Medicaid Denial/Botox

July 2, 2003

In a message dated 7/2/2003 8:21:33 AM Central Daylight Time,

dfreels@... writes:

> Lynn,

>

> Botox for cp is very much off-label and the manufacturer is in direct

> violation of FDA requirements by promoting the off-label use of Botox for

> cp, which can be seen and ordered at http://www.wemove.org/spa_chemvid.html

> .

>

> This is a video on how to administer botox which also comes with a

> 10-question, multiple choice test that the physician can answer and mail

> back to get CME credit (continuing medical education).

>

Lynn in this statement that Freel's wrote he is correct it is very much

off labeled for use the botox. However what I have found out in research and

study is that Dr.s and Physicians in mainstreem medicine use it everyday. The

Key Word is they all agree within the medical community that it is a viable

treatment. See that is the problem we are not getting there message. If we all

understood what they were telling us when they say that HBOT is considered

Experimental and Investigational then we could fight this fight a little easier.

See the medical community is Dr.s Insurance companies and they all agree that

HBOT is not been proven why is this. I'll explain. See they say it has not been

proven because it jeopardizes there income. But you see Now Botox they all

can agree it is a viable though off labeled treatment and cover it within there

scope of benefits because why. It makes them money they get money on follow up

visits and it feeds there families. Believe it or not hone the good old USA

is more communist than you realize.

Darin

July 2, 2003

>

>> I've always been under the impression HBOT IS FDA approved? <

>

>This is just an observation but it's a bit ironic that Maine Medicaid

>denied coverage based on lack of FDA approval, but I'll bet they

>cover things like Botox or other medications which are FDA-approved

>for adults but not children. When I mentioned to our physiatrist

>that I didn't think Botox was FDA-approved for children, she a)

>didn't know if it was or not and didn't seem to care. Seems to me

>that it's not really about the FDA approval at all, but rather

>whether a given treatment is mainstream or not.

>

>Lynn

Lynn,

Botox for cp is very much off-label and the manufacturer is in direct

violation of FDA requirements by promoting the off-label use of Botox for

cp, which can be seen and ordered at http://www.wemove.org/spa_chemvid.html

..

This is a video on how to administer botox which also comes with a

10-question, multiple choice test that the physician can answer and mail

back to get CME credit (continuing medical education).

(Of course, the answers to the questions are also included.)

I have a copy of the video and have made copies for parents who have a

hearing before an Administrative Law Judge (ALJ) because it is a great

demonstration of the marketing techniques used to influence physicians and

is such an outstanding case in point of today's ludicrous medical decision

making.

Most pediatric neurologists have either administered or prescribed botox,

which is derived from the most poisonous substance on the planet--botulin

toxin. This is the very same stuff used to create Weapons of Mass

Destruction, which by the way, a recent war was fought in an effort to

eliminate botulin toxin.

This war was fought and won by the very same United States government who

carried into battle hyperbaric chambers--just in case they ran into some

botox. See http://ihausa.org/newsletter/htm/aug_2002/page_1.htm .

(Because you see, off-label High-Dosage Oxygen Therapy can detoxify a

person who's gotten too much botulin. There's a paper on this at

medicaid/files/ .)

(Is this crazy or what? The same government that prevents access to

off-label HDOT permits the off-label use of Botox, yet they're willing to

wage war against massive off-label Botox--and use off-label HDOT in case

they run tnto that same off-label Botox--yet the most fragile among us, our

brain-injured children, they're more than willing to subject to and inject

with off-label Botox and deny HDOT.)

Anyway, when you get to the hearing, you ask the state witnesses if they

prescribe the off-label use of Botox, and when they say yes, and then you

ask them why and ask if they're aware of the dangers, and that wars have

been fought to prevent the off-label administration of botulin toxin, and

then you whip out this botox video and show it and enter it into evidence

and make a huge dent in the judge's thinking into just how medical decision

making is done in pediatric medicine.

Next, you can then ask this very same witness/physician if he/she would

prescribe High-Dosage Oxygen Therapy and he/she will then also testify that

(incredibly) it's too dangerous to prescribe the one substance that none of

us can live without.

It's also helpful to first set up the witness(es) by asking if they ever

use the Physician's Desk Reference (PDR), a 15-pound book that is a

compilation of all the labels and literature inserts of every FDA-approved

drug. They have these things in every library and most doctors have 3 or 4

extras lying around. You ask the doc their opinion of the PDR and most will

describe it as their " bible. "

Then you let them say things like " it's my best resource " and " it's the

best authority. " Then ask them to look up things prescribed for your child

and there's a greater than 90% chance the PDR will say " not FDA approved

for pediatric use. "

Then, once the witness(es) testify that prescribing extra oxygen is too

dangerous, have them look up " hyperbaric " in the PDR.

They won't find it.

Then ask them to look up " oxygen. "

It's not in there either.

So then you or your attorney asks how they can make a decision to deny

High-Dosage Oxygen Therapy when there's no reference to it in their " best

authority " --yet they are willing to prescribe a substance off-label, where

the off-label use of the same substance has caused a war to be fought and

people have died?

I'm sure there are even more homeruns that can be hit with this comparison,

but the point that needs to be made is that medical decision making in

pediatrics is more a matter of successful marketing than science.

You can use any commonly precscribed off-label drug to illustrate the

point; however, botox works well since there is this video out there with

CME credit and a recent war has been fought to prevent the off-label use of

botulin toxin.

I think the botox example just further drives home the point of how

ridiculous this all is and will help the ALJ " see " what's really going on

here.

We have another ALJ hearing soon, and I certainly intend to enter the botox

video into evidence as a demonstration of how there's no one around to

spend millions on advertising High-Dosage Oxygen Therapy since they'll

never see a return because there is nothing to patent.

```````````````````````````````````````````````````````

" Rarely do we find men who willingly engage in hard, solid thinking. There

is an almost universal quest for easy answers and half-baked solutions. "

--The Reverend Luther King, Jr.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

707/220-7224 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 2, 2003

We are having the same problem getting Medicaid to pay for HBOT in Florida.

They say they will pay if you go to a hospital, so then we call our local

hospital where they have a chamber and where our son was born at the women's

hospital and stayed in their NICU for 6 months, and they tell you that CP is not

one of the 13 indicated diagnosis for treatment with the hyperbaric. It's

pretty frustrating that they work to keep these preemies alive in their NICU,

but then they don't want to do anything to help out once they have a disability

from being so premature!!!! And Medicaid can cover their butt because they say

Oh, we will pay, you just have to go to a hospital. And the hospital covers

their butt by saying it's not an approved diagnosis. So basically it is a tough

system to break through, but a Neurologist in the area is trying to break it.

Has anyone else encountered the same situation??

Thanks, Christy

Re: [MedicaidforHDOT] Medicaid Denial/Botox

>

>> I've always been under the impression HBOT IS FDA approved? <

>

>This is just an observation but it's a bit ironic that Maine Medicaid

>denied coverage based on lack of FDA approval, but I'll bet they

>cover things like Botox or other medications which are FDA-approved

>for adults but not children. When I mentioned to our physiatrist

>that I didn't think Botox was FDA-approved for children, she a)

>didn't know if it was or not and didn't seem to care. Seems to me

>that it's not really about the FDA approval at all, but rather

>whether a given treatment is mainstream or not.

>

>Lynn

Lynn,

Botox for cp is very much off-label and the manufacturer is in direct

violation of FDA requirements by promoting the off-label use of Botox for

cp, which can be seen and ordered at http://www.wemove.org/spa_chemvid.html

.

This is a video on how to administer botox which also comes with a

10-question, multiple choice test that the physician can answer and mail

back to get CME credit (continuing medical education).

(Of course, the answers to the questions are also included.)

I have a copy of the video and have made copies for parents who have a

hearing before an Administrative Law Judge (ALJ) because it is a great

demonstration of the marketing techniques used to influence physicians and

is such an outstanding case in point of today's ludicrous medical decision

making.

Most pediatric neurologists have either administered or prescribed botox,

which is derived from the most poisonous substance on the planet--botulin

toxin. This is the very same stuff used to create Weapons of Mass

Destruction, which by the way, a recent war was fought in an effort to

eliminate botulin toxin.

This war was fought and won by the very same United States government who

carried into battle hyperbaric chambers--just in case they ran into some

botox. See http://ihausa.org/newsletter/htm/aug_2002/page_1.htm .

(Because you see, off-label High-Dosage Oxygen Therapy can detoxify a

person who's gotten too much botulin. There's a paper on this at

medicaid/files/ .)

(Is this crazy or what? The same government that prevents access to

off-label HDOT permits the off-label use of Botox, yet they're willing to

wage war against massive off-label Botox--and use off-label HDOT in case

they run tnto that same off-label Botox--yet the most fragile among us, our

brain-injured children, they're more than willing to subject to and inject

with off-label Botox and deny HDOT.)

Anyway, when you get to the hearing, you ask the state witnesses if they

prescribe the off-label use of Botox, and when they say yes, and then you

ask them why and ask if they're aware of the dangers, and that wars have

been fought to prevent the off-label administration of botulin toxin, and

then you whip out this botox video and show it and enter it into evidence

and make a huge dent in the judge's thinking into just how medical decision

making is done in pediatric medicine.

Next, you can then ask this very same witness/physician if he/she would

prescribe High-Dosage Oxygen Therapy and he/she will then also testify that

(incredibly) it's too dangerous to prescribe the one substance that none of

us can live without.

It's also helpful to first set up the witness(es) by asking if they ever

use the Physician's Desk Reference (PDR), a 15-pound book that is a

compilation of all the labels and literature inserts of every FDA-approved

drug. They have these things in every library and most doctors have 3 or 4

extras lying around. You ask the doc their opinion of the PDR and most will

describe it as their " bible. "

Then you let them say things like " it's my best resource " and " it's the

best authority. " Then ask them to look up things prescribed for your child

and there's a greater than 90% chance the PDR will say " not FDA approved

for pediatric use. "

Then, once the witness(es) testify that prescribing extra oxygen is too

dangerous, have them look up " hyperbaric " in the PDR.

They won't find it.

Then ask them to look up " oxygen. "

It's not in there either.

So then you or your attorney asks how they can make a decision to deny

High-Dosage Oxygen Therapy when there's no reference to it in their " best

authority " --yet they are willing to prescribe a substance off-label, where

the off-label use of the same substance has caused a war to be fought and

people have died?

I'm sure there are even more homeruns that can be hit with this comparison,

but the point that needs to be made is that medical decision making in

pediatrics is more a matter of successful marketing than science.

You can use any commonly precscribed off-label drug to illustrate the

point; however, botox works well since there is this video out there with

CME credit and a recent war has been fought to prevent the off-label use of

botulin toxin.

I think the botox example just further drives home the point of how

ridiculous this all is and will help the ALJ " see " what's really going on

here.

We have another ALJ hearing soon, and I certainly intend to enter the botox

video into evidence as a demonstration of how there's no one around to

spend millions on advertising High-Dosage Oxygen Therapy since they'll

never see a return because there is nothing to patent.

```````````````````````````````````````````````````````

" Rarely do we find men who willingly engage in hard, solid thinking. There

is an almost universal quest for easy answers and half-baked solutions. "

--The Reverend Luther King, Jr.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

707/220-7224 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 2, 2003

THe hospital based HBOT units a run by those that feel they will be

breaking a rule and therefore jeopordize reimbursement if they treat

off-label indications. THere is no such rule!

KP Stoller, MD, FAAP

Assistant Clinical Prof, UNM HSC Dept Pediatrics

Simply Hyperbarics

www.simplyhyperbarics.com

> We are having the same problem getting Medicaid to pay for HBOT in

> Florida. They say they will pay if you go to a hospital, so then we

> call our local hospital where they have a chamber and where our son was

> born at the women's hospital and stayed in their NICU for 6 months, and

> they tell you that CP is not one of the 13 indicated diagnosis for

> treatment with the hyperbaric. It's pretty frustrating that they work

> to keep these preemies alive in their NICU, but then they don't want to

> do anything to help out once they have a disability from being so

> premature!!!! And Medicaid can cover their butt because they say Oh, we

> will pay, you just have to go to a hospital. And the hospital covers

> their butt by saying it's not an approved diagnosis. So basically it is

> a tough system to break through, but a Neurologist in the area is trying

> to break it. Has anyone else encountered the same situation?? Thanks,

> Christy

> Re: [MedicaidforHDOT] Medicaid Denial/Botox

>

> >

> >> I've always been under the impression HBOT IS FDA approved? <

> >

> >This is just an observation but it's a bit ironic that Maine Medicaid

> denied coverage based on lack of FDA approval, but I'll bet they

> cover things like Botox or other medications which are FDA-approved

> for adults but not children. When I mentioned to our physiatrist

> that I didn't think Botox was FDA-approved for children, she a)

> didn't know if it was or not and didn't seem to care. Seems to me

> that it's not really about the FDA approval at all, but rather

> >whether a given treatment is mainstream or not.

> >

> >Lynn

>

> Lynn,

>

> Botox for cp is very much off-label and the manufacturer is in direct

> violation of FDA requirements by promoting the off-label use of Botox

> for cp, which can be seen and ordered at

> http://www.wemove.org/spa_chemvid.html .

>

> This is a video on how to administer botox which also comes with a

> 10-question, multiple choice test that the physician can answer and

> mail back to get CME credit (continuing medical education).

>

> (Of course, the answers to the questions are also included.)

>

> I have a copy of the video and have made copies for parents who have a

> hearing before an Administrative Law Judge (ALJ) because it is a great

> demonstration of the marketing techniques used to influence physicians

> and is such an outstanding case in point of today's ludicrous medical

> decision making.

>

> Most pediatric neurologists have either administered or prescribed

> botox, which is derived from the most poisonous substance on the

> planet--botulin toxin. This is the very same stuff used to create

> Weapons of Mass Destruction, which by the way, a recent war was fought

> in an effort to eliminate botulin toxin.

>

> This war was fought and won by the very same United States government

> who carried into battle hyperbaric chambers--just in case they ran

> into some botox. See

> http://ihausa.org/newsletter/htm/aug_2002/page_1.htm .

>

> (Because you see, off-label High-Dosage Oxygen Therapy can detoxify a

> person who's gotten too much botulin. There's a paper on this at

> medicaid/files/ .)

>

> (Is this crazy or what? The same government that prevents access to

> off-label HDOT permits the off-label use of Botox, yet they're willing

> to wage war against massive off-label Botox--and use off-label HDOT in

> case they run tnto that same off-label Botox--yet the most fragile

> among us, our brain-injured children, they're more than willing to

> subject to and inject with off-label Botox and deny HDOT.)

>

> Anyway, when you get to the hearing, you ask the state witnesses if

> they prescribe the off-label use of Botox, and when they say yes, and

> then you ask them why and ask if they're aware of the dangers, and

> that wars have been fought to prevent the off-label administration of

> botulin toxin, and then you whip out this botox video and show it and

> enter it into evidence and make a huge dent in the judge's thinking

> into just how medical decision making is done in pediatric medicine.

>

> Next, you can then ask this very same witness/physician if he/she

> would prescribe High-Dosage Oxygen Therapy and he/she will then also

> testify that (incredibly) it's too dangerous to prescribe the one

> substance that none of us can live without.

>

> It's also helpful to first set up the witness(es) by asking if they

> ever use the Physician's Desk Reference (PDR), a 15-pound book that is

> a compilation of all the labels and literature inserts of every

> FDA-approved drug. They have these things in every library and most

> doctors have 3 or 4 extras lying around. You ask the doc their opinion

> of the PDR and most will describe it as their " bible. "

>

> Then you let them say things like " it's my best resource " and " it's

> the best authority. " Then ask them to look up things prescribed for

> your child and there's a greater than 90% chance the PDR will say " not

> FDA approved for pediatric use. "

>

> Then, once the witness(es) testify that prescribing extra oxygen is

> too dangerous, have them look up " hyperbaric " in the PDR.

>

> They won't find it.

>

> Then ask them to look up " oxygen. "

>

> It's not in there either.

>

> So then you or your attorney asks how they can make a decision to deny

> High-Dosage Oxygen Therapy when there's no reference to it in their

> " best authority " --yet they are willing to prescribe a substance

> off-label, where the off-label use of the same substance has caused a

> war to be fought and people have died?

>

> I'm sure there are even more homeruns that can be hit with this

> comparison, but the point that needs to be made is that medical

> decision making in pediatrics is more a matter of successful marketing

> than science.

>

> You can use any commonly precscribed off-label drug to illustrate the

> point; however, botox works well since there is this video out there

> with CME credit and a recent war has been fought to prevent the

> off-label use of botulin toxin.

>

> I think the botox example just further drives home the point of how

> ridiculous this all is and will help the ALJ " see " what's really going

> on here.

>

> We have another ALJ hearing soon, and I certainly intend to enter the

> botox video into evidence as a demonstration of how there's no one

> around to spend millions on advertising High-Dosage Oxygen Therapy

> since they'll never see a return because there is nothing to patent.

>

> ```````````````````````````````````````````````````````

> " Rarely do we find men who willingly engage in hard, solid thinking.

> There is an almost universal quest for easy answers and half-baked

> solutions. "

>

> --The Reverend Luther King,

> Jr.

>

> ```````````````````````````````````````````````````````

>

> Freels

> 2948 Windfield Circle

> Tucker, GA 30084-6714

> 770/491-6776 (phone and fax)

> 707/220-7224 (efax, sends fax as email attachment)

> mailto:dfreels@...

>

> http://www.freelanceforum.org/df

>

July 2, 2003

Ken,

The gentleman that I spoke to at the hospital said he checked with the medical

director and it is their policy!! Is it worth me contacting the medical

director to fight this??

Thanks,Christy

Re: [MedicaidforHDOT] Medicaid Denial/Botox

>

> >

> >> I've always been under the impression HBOT IS FDA approved? <

> >

> >This is just an observation but it's a bit ironic that Maine Medicaid

> denied coverage based on lack of FDA approval, but I'll bet they

> cover things like Botox or other medications which are FDA-approved

> for adults but not children. When I mentioned to our physiatrist

> that I didn't think Botox was FDA-approved for children, she a)

> didn't know if it was or not and didn't seem to care. Seems to me

> that it's not really about the FDA approval at all, but rather

> >whether a given treatment is mainstream or not.

> >

> >Lynn

>

> Lynn,

>

> Botox for cp is very much off-label and the manufacturer is in direct

> violation of FDA requirements by promoting the off-label use of Botox

> for cp, which can be seen and ordered at

> http://www.wemove.org/spa_chemvid.html .

>

> This is a video on how to administer botox which also comes with a

> 10-question, multiple choice test that the physician can answer and

> mail back to get CME credit (continuing medical education).

>

> (Of course, the answers to the questions are also included.)

>

> I have a copy of the video and have made copies for parents who have a

> hearing before an Administrative Law Judge (ALJ) because it is a great

> demonstration of the marketing techniques used to influence physicians

> and is such an outstanding case in point of today's ludicrous medical

> decision making.

>

> Most pediatric neurologists have either administered or prescribed

> botox, which is derived from the most poisonous substance on the

> planet--botulin toxin. This is the very same stuff used to create

> Weapons of Mass Destruction, which by the way, a recent war was fought

> in an effort to eliminate botulin toxin.

>

> This war was fought and won by the very same United States government

> who carried into battle hyperbaric chambers--just in case they ran

> into some botox. See

> http://ihausa.org/newsletter/htm/aug_2002/page_1.htm .

>

> (Because you see, off-label High-Dosage Oxygen Therapy can detoxify a

> person who's gotten too much botulin. There's a paper on this at

> medicaid/files/ .)

>

> (Is this crazy or what? The same government that prevents access to

> off-label HDOT permits the off-label use of Botox, yet they're willing

> to wage war against massive off-label Botox--and use off-label HDOT in

> case they run tnto that same off-label Botox--yet the most fragile

> among us, our brain-injured children, they're more than willing to

> subject to and inject with off-label Botox and deny HDOT.)

>

> Anyway, when you get to the hearing, you ask the state witnesses if

> they prescribe the off-label use of Botox, and when they say yes, and

> then you ask them why and ask if they're aware of the dangers, and

> that wars have been fought to prevent the off-label administration of

> botulin toxin, and then you whip out this botox video and show it and

> enter it into evidence and make a huge dent in the judge's thinking

> into just how medical decision making is done in pediatric medicine.

>

> Next, you can then ask this very same witness/physician if he/she

> would prescribe High-Dosage Oxygen Therapy and he/she will then also

> testify that (incredibly) it's too dangerous to prescribe the one

> substance that none of us can live without.

>

> It's also helpful to first set up the witness(es) by asking if they

> ever use the Physician's Desk Reference (PDR), a 15-pound book that is

> a compilation of all the labels and literature inserts of every

> FDA-approved drug. They have these things in every library and most

> doctors have 3 or 4 extras lying around. You ask the doc their opinion

> of the PDR and most will describe it as their " bible. "

>

> Then you let them say things like " it's my best resource " and " it's

> the best authority. " Then ask them to look up things prescribed for

> your child and there's a greater than 90% chance the PDR will say " not

> FDA approved for pediatric use. "

>

> Then, once the witness(es) testify that prescribing extra oxygen is

> too dangerous, have them look up " hyperbaric " in the PDR.

>

> They won't find it.

>

> Then ask them to look up " oxygen. "

>

> It's not in there either.

>

> So then you or your attorney asks how they can make a decision to deny

> High-Dosage Oxygen Therapy when there's no reference to it in their

> " best authority " --yet they are willing to prescribe a substance

> off-label, where the off-label use of the same substance has caused a

> war to be fought and people have died?

>

> I'm sure there are even more homeruns that can be hit with this

> comparison, but the point that needs to be made is that medical

> decision making in pediatrics is more a matter of successful marketing

> than science.

>

> You can use any commonly precscribed off-label drug to illustrate the

> point; however, botox works well since there is this video out there

> with CME credit and a recent war has been fought to prevent the

> off-label use of botulin toxin.

>

> I think the botox example just further drives home the point of how

> ridiculous this all is and will help the ALJ " see " what's really going

> on here.

>

> We have another ALJ hearing soon, and I certainly intend to enter the

> botox video into evidence as a demonstration of how there's no one

> around to spend millions on advertising High-Dosage Oxygen Therapy

> since they'll never see a return because there is nothing to patent.

>

> ```````````````````````````````````````````````````````

> " Rarely do we find men who willingly engage in hard, solid thinking.

> There is an almost universal quest for easy answers and half-baked

> solutions. "

>

> --The Reverend Luther King,

> Jr.

>

> ```````````````````````````````````````````````````````

>

> Freels

> 2948 Windfield Circle

> Tucker, GA 30084-6714

> 770/491-6776 (phone and fax)

> 707/220-7224 (efax, sends fax as email attachment)

> mailto:dfreels@...

>

> http://www.freelanceforum.org/df

>

July 2, 2003

, I completely agree with your comments. That is why it

absolutely drives me nuts that not only is Henry's physician pushing

Botox but our insurance plan will PAY for it.

Lynn

> Lynn,

>

> Botox for cp is very much off-label and the manufacturer is in

direct

> violation of FDA requirements by promoting the off-label use of

Botox for

> cp, which can be seen and ordered at

http://www.wemove.org/spa_chemvid.html

> .

>

> This is a video on how to administer botox which also comes with a

> 10-question, multiple choice test that the physician can answer and

mail

> back to get CME credit (continuing medical education).

>

> (Of course, the answers to the questions are also included.)

>

> I have a copy of the video and have made copies for parents who

have a

> hearing before an Administrative Law Judge (ALJ) because it is a

great

> demonstration of the marketing techniques used to influence

physicians and

> is such an outstanding case in point of today's ludicrous medical

decision

> making.

>

> Most pediatric neurologists have either administered or prescribed

botox,

> which is derived from the most poisonous substance on the planet--

botulin

> toxin. This is the very same stuff used to create Weapons of Mass

> Destruction, which by the way, a recent war was fought in an effort

to

> eliminate botulin toxin.

>

> This war was fought and won by the very same United States

government who

> carried into battle hyperbaric chambers--just in case they ran into

some

> botox. See http://ihausa.org/newsletter/htm/aug_2002/page_1.htm .

>

> (Because you see, off-label High-Dosage Oxygen Therapy can detoxify

a

> person who's gotten too much botulin. There's a paper on this at

> medicaid/files/ .)

>

> (Is this crazy or what? The same government that prevents access to

> off-label HDOT permits the off-label use of Botox, yet they're

willing to

> wage war against massive off-label Botox--and use off-label HDOT in

case

> they run tnto that same off-label Botox--yet the most fragile among

us, our

> brain-injured children, they're more than willing to subject to and

inject

> with off-label Botox and deny HDOT.)

>

> Anyway, when you get to the hearing, you ask the state witnesses if

they

> prescribe the off-label use of Botox, and when they say yes, and

then you

> ask them why and ask if they're aware of the dangers, and that wars

have

> been fought to prevent the off-label administration of botulin

toxin, and

> then you whip out this botox video and show it and enter it into

evidence

> and make a huge dent in the judge's thinking into just how medical

decision

> making is done in pediatric medicine.

>

> Next, you can then ask this very same witness/physician if he/she

would

> prescribe High-Dosage Oxygen Therapy and he/she will then also

testify that

> (incredibly) it's too dangerous to prescribe the one substance that

none of

> us can live without.

>

> It's also helpful to first set up the witness(es) by asking if they

ever

> use the Physician's Desk Reference (PDR), a 15-pound book that is a

> compilation of all the labels and literature inserts of every FDA-

approved

> drug. They have these things in every library and most doctors have

3 or 4

> extras lying around. You ask the doc their opinion of the PDR and

most will

> describe it as their " bible. "

>

> Then you let them say things like " it's my best resource " and " it's

the

> best authority. " Then ask them to look up things prescribed for

your child

> and there's a greater than 90% chance the PDR will say " not FDA

approved

> for pediatric use. "

>

> Then, once the witness(es) testify that prescribing extra oxygen is

too

> dangerous, have them look up " hyperbaric " in the PDR.

>

> They won't find it.

>

> Then ask them to look up " oxygen. "

>

> It's not in there either.

>

> So then you or your attorney asks how they can make a decision to

deny

> High-Dosage Oxygen Therapy when there's no reference to it in

their " best

> authority " --yet they are willing to prescribe a substance off-

label, where

> the off-label use of the same substance has caused a war to be

fought and

> people have died?

>

> I'm sure there are even more homeruns that can be hit with this

comparison,

> but the point that needs to be made is that medical decision making

in

> pediatrics is more a matter of successful marketing than science.

>

> You can use any commonly precscribed off-label drug to illustrate

the

> point; however, botox works well since there is this video out

there with

> CME credit and a recent war has been fought to prevent the off-

label use of

> botulin toxin.

>

> I think the botox example just further drives home the point of how

> ridiculous this all is and will help the ALJ " see " what's really

going on

> here.

>

> We have another ALJ hearing soon, and I certainly intend to enter

the botox

> video into evidence as a demonstration of how there's no one around

to

> spend millions on advertising High-Dosage Oxygen Therapy since

they'll

> never see a return because there is nothing to patent.

>

> ```````````````````````````````````````````````````````

> " Rarely do we find men who willingly engage in hard, solid

thinking. There

> is an almost universal quest for easy answers and half-baked

solutions. "

>

> --The Reverend Luther

King, Jr.

>

> ```````````````````````````````````````````````````````

>

> Freels

> 2948 Windfield Circle

> Tucker, GA 30084-6714

> 770/491-6776 (phone and fax)

> 707/220-7224 (efax, sends fax as email attachment)

> mailto:dfreels@m...

>

> http://www.freelanceforum.org/df

July 2, 2003

> It's pretty frustrating that they work to keep these preemies alive

in their NICU, but then they don't want to do anything to help out

once they have a disability from being so premature!!!! And Medicaid

can cover their butt because they say Oh, we will pay, you just have

to go to a hospital. And the hospital covers their butt by saying

it's not an approved diagnosis. So basically it is a tough system to

break through, but a Neurologist in the area is trying to break it.

Has anyone else encountered the same situation?? < <

Christy, we are going through this EXACT situation right now and have

a hearing with our insurance company (our local chamber which

rejected our request for treatment, our physician group and our

health insurance company are all owned by the same health care

system) sometime late this summer. I completely agree, it is very

frustrating.

Lynn

July 2, 2003

> THe hospital based HBOT units a run by those that feel they will be

> breaking a rule and therefore jeopordize reimbursement if they treat

> off-label indications. THere is no such rule!

>

> KP Stoller, MD, FAAP

> Assistant Clinical Prof, UNM HSC Dept Pediatrics

> Simply Hyperbarics

> www.simplyhyperbarics.com

==================

Dr. Stoller, this was my first thought also. However, I've been todl

that the problem comes in in how much is charged. For example, the

charge billed by our local hospital's chamber to insurance, Medicaid,

Medicare, etc. for " approved " indications is somewhere over $1000 per

treatment. That means that if, by some miracle, they agreed to treat

my son's brain injury, they would have to charge me that same prive

for each treatment to my son or risk being charged with

Medicaid/Medicare fraud. At that point, even if I wanted to have my

son treated in their chamber, they've precluded themselves on the

price issue alone.

Lynn

July 2, 2003

Lynn Contact me if you can at 972-427-8825 or 972-824-3416. We have just been

able to access insurance for another patient we have been working with for

some time through Blue Cross Blue Shield. I would like to help you if I can. We

faced some of the same issues that you are going through now.

Darin

July 2, 2003

Darin, y'all aren't telling me anything I haven't seen firsthand,

believe you, me. The whole thing is so money driven that it disgusts

me. I have no problem with anyone making a living and I think docs

earn their income because they have responsibilities that the average

Joe cannot ever comprehend. I, for one, never want to be responsible

for the life and death of another human being. Where I get upset is

when it is so very obvious that the reason HBOT is not accepted in

the medical community is because it is not nor will it ever be a

profit center. Yes, it would be wonderful if there were a follow-up

to the McGill study that addressed the issues in the McGill study and

put to rest these recurrent, annoying but nonetheless damaging

concerns regarding HBOT and brain injuries. But that will likely

never happen. Why? Because unlike Botox or any other patentable

pharmaceutical, HBOT is based on O2, a inexpensive, non patentable

substance. This means that pharmaceutical companies who are

responsible for funding the majority of medical research will never

fund an HBOT study unless they can be persuaded that there is money

to be made. And who said it was LOVE that made the world go 'round?

Sorry, in the end, I think it might really be the LOVE of MONEY.

Lynn

> > Lynn in this statement that Freel's wrote he is correct it

is very much off labeled for use the botox. However what I have found

out in research and study is that Dr.s and Physicians in mainstreem

medicine use it everyday. The Key Word is they all agree within the

medical community that it is a viable treatment. See that is the

problem we are not getting there message. If we all understood what

they were telling us when they say that HBOT is considered

experimental and Investigational then we could fight this fight a

little easier. See the medical community is Dr.s Insurance companies

and they all agree that HBOT is not been proven why is this. I'll

explain. See they say it has not been proven because it jeopardizes

there income. But you see Now Botox they all can agree it is a viable

though off labeled treatment and cover it within there scope of

benefits because why. It makes them money they get money on follow up

visits and it feeds there families. Believe it or not hone the good

old USA is more communist than you realize. < <

July 2, 2003

>Ken,

>The gentleman that I spoke to at the hospital said he checked with the

>medical director and it is their policy!! Is it worth me contacting the

>medical director to fight this??

>Thanks,Christy

Christy,

(and all other list members)

Yes, this is definitely worth fighting as THIS is the fight.

Here's what you do.

First, sit down and write a letter to the hospital (and other hospitals

with hyperbaric chambers), and ask if your brain-injured child can receive

Hyperbaric Oxygen Therapy in their hyperbaric chamber.

Do this in writing, so you will get a response in writing. Don't even

include a telephone number or email address as part of your return address.

Use just your mailing address.

It is essential that you make a written request so that you will get a

written response. In your request, be sure and include your child's

diagnosis. Here's why. When they write back denying treatment based on

diagnosis, you will then possess documentation of a medical treatment based

on diagnosis.

Under the Americans with Disabilities Act this is absolutely illegal. This

is so illegal that it won't be hard at all for any judge to throw the book

at them. This is the same thing as a restaurant refusing to serve somebody

because they're in a wheelchair because they have cp.

(After you get this letter in writing, set up an appointment with the

hospital administrator to discuss this denial of off-label HBOT. If

possible bring along a member of the press--unannounced of course.)

I think most of these hospital denials are based on ignorance of the

history of off-label uses as opposed to anything truly sinister, though I

could be wrong. Most people in healthcare truly care and truly want to

help. If we can show them how, most will gladly help. I think your local

hospital administrator will also gladly help, especially if he has a better

idea of what this all means and having the local press in tow also helps

too (that's why they're called " the press " ). You could also bring along

some of Neubauer's before/after video so the hospital administrator could

see some dramatic HBOT efficacy.

Also, since you've contacted the same hospital where he was kept as a

preemie, I encourage you to download the 1963 paper on HBOT for asphyxiated

newborns found on HDO-documentation/files/

[The direct link is

http://f6.grp.fs.com/v1/cPMCP9Ce0Vw68YuNwIdAqgztV65VTVXqoKuym9LNyezu-Vsc5Mv

bYfNdOZJ1mv33DqzgH5W-vha4uQcj/HBOT.resuscitation.newborn.PDF ] . He might

think this is interesting too. It won't hurt either to semi-plant the idea

in his head that if your child had received HBOT in the neonatal unit then

maybe he/she wouldn't need HBOT now.

(Such a planted thought can also grow further wonders on potential

liability, another motivator.)

Ken Locklear told us all to write these letter requests about a year ago

and none of us did it. Under the new IHMA leadership--now based in

Washington, DC--if we collect maybe 1000 letters from hospitals across the

country denying HBOT based on diagnosis, i.e., cp, those letters can be

presented to the US Dept. of Justice which has a special department set up

just to prosecute violations of the ADA.

This is a cinch.

Second, if you haven't joined the International Hyperbaric Medical

Association, join now. We should all join. They are refocused and

re-energized. The link to join is the first one at the end of every post

from the listserv.

Or just click here.

http://www.hyperbaricmedicalassociation.org/forms/Friends_of_IHMA_Join.pdf

There was some discussion about this the other day and some confusion.

There is another organization called the International Hyperbaric

Association. This is a good group too and especially supportive of parents

and other caregivers who are providing HBOT at home.

The third and oldest group is the Undersea and Hyperbaric Medical Society

(UHMS), which has historically fought against the off-label use of HBOT,

though maybe that's changing since e Creacy is now a UHMS member.

e, is the UHMS now endorsing off-label uses since you've joined?

Now while all three organizations have their attributes, the IHMA will

probably do more to help HBOT become part of mainstream medicine. At only

$25 a year I know my money will be spent more effectively here.

> Re: [MedicaidforHDOT] Medicaid Denial/Botox

>

> THe hospital based HBOT units a run by those that feel they will be

> breaking a rule and therefore jeopordize reimbursement if they treat

> off-label indications. THere is no such rule!

>

> KP Stoller, MD, FAAP

> Assistant Clinical Prof, UNM HSC Dept Pediatrics

> Simply Hyperbarics

> www.simplyhyperbarics.com

>

> > We are having the same problem getting Medicaid to pay for HBOT in

> > Florida. They say they will pay if you go to a hospital, so then we

> > call our local hospital where they have a chamber and where our son was

> > born at the women's hospital and stayed in their NICU for 6 months, and

> > they tell you that CP is not one of the 13 indicated diagnosis for

> > treatment with the hyperbaric. It's pretty frustrating that they work

> > to keep these preemies alive in their NICU, but then they don't want to

> > do anything to help out once they have a disability from being so

> > premature!!!! And Medicaid can cover their butt because they say Oh, we

> > will pay, you just have to go to a hospital. And the hospital covers

> > their butt by saying it's not an approved diagnosis. So basically it is

> > a tough system to break through, but a Neurologist in the area is trying

> > to break it. Has anyone else encountered the same situation?? Thanks,

> > Christy

```````````````````````````````````````````````````````

" Rarely do we find men who willingly engage in hard, solid thinking. There

is an almost universal quest for easy answers and half-baked solutions. "

--The Reverend Luther King, Jr.

```````````````````````````````````````````````````````

Freels

2948 Windfield Circle

Tucker, GA 30084-6714

770/491-6776 (phone and fax)

707/220-7224 (efax, sends fax as email attachment)

mailto:dfreels@...

http://www.freelanceforum.org/df

July 2, 2003

> > First, sit down and write a letter to the hospital (and other

hospitals with hyperbaric chambers), and ask if your brain-injured

child can receive Hyperbaric Oxygen Therapy in their hyperbaric

chamber. Do this in writing, so you will get a response in writing.

It is essential that you make a written request so that you will get a

written response. In your request, be sure and include your child's

diagnosis. Here's why. When they write back denying treatment based on

diagnosis, you will then possess documentation of a medical treatment

based on diagnosis. Under the Americans with Disabilities Act this is

absolutely illegal. This is so illegal that it won't be hard at all

for any judge to throw the book at them. This is the same thing as a

restaurant refusing to serve somebody because they're in a wheelchair

because they have cp. < <

, as I have explained in my previous e-mails, our hospital, our

docs and our insurance are all owned by the same company. We are

submitting a request to the insurance company to be reimbursed for my

son's HBOT - we fully expect it will denied, either because they

consider HBOT to be experimental or because we used an out-of-plan

provider. I am not quite sure where you comments regarding the ADA

will apply to us as I do not believe they will be denying his

treatment based on the fact that he has CP but because they feel HBOT

for brain injuries in general is yet unproven and/or because we did

not use their facility. Am I misunderstanding your instructions?

BTW, I did call the hospital and was told that they do not treat

brain injuries. I will send a letter and get that in writing though.

Lynn

July 2, 2003

Christy:

Yes, it is their policy - a policy that is based almost essentially on the

suppression of neuro rehab. Now, those who implement this policy my not

realize that, or have any idea how this policy came into effect other than

knowing they don't treat outside the " 13 " approved Dx's; nevertheless,

that is what is behind these rigid policies.

Even so, I know some of the hospital based centers will treat off-label

for inpatients on humanitarian grounds, that is they don't charge.

Understand, someone has put the fear of God into these centers that if

they charge for off-label indications they will lose their ability to seem

reimbursement from Medicare. Dr. Duncan (Congressman Istook's

associate in OK confirmed that this is totally wrong and unfounded).

KP Stoller, MD, FAAP

Assistant Clinical Prof, UNM HSC Dept Pediatrics

Simply Hyperbarics

www.simplyhyperbarics.com

> Ken,

> The gentleman that I spoke to at the hospital said he checked with the

> medical director and it is their policy!! Is it worth me contacting the

> medical director to fight this?? Thanks,Christy

> Re: [MedicaidforHDOT] Medicaid Denial/Botox

> >

> > >

> > >> I've always been under the impression HBOT IS FDA approved? <

> > >

> > >This is just an observation but it's a bit ironic that Maine

> Medicaid

> > denied coverage based on lack of FDA approval, but I'll bet they

> cover things like Botox or other medications which are FDA-approved

> for adults but not children. When I mentioned to our physiatrist

> that I didn't think Botox was FDA-approved for children, she a)

> didn't know if it was or not and didn't seem to care. Seems to

> me that it's not really about the FDA approval at all, but rather

> > >whether a given treatment is mainstream or not.

> > >

> > >Lynn

> >

> > Lynn,

> >

> > Botox for cp is very much off-label and the manufacturer is in

> direct

> > violation of FDA requirements by promoting the off-label use of

> Botox for cp, which can be seen and ordered at

> > http://www.wemove.org/spa_chemvid.html .

> >

> > This is a video on how to administer botox which also comes with a

> > 10-question, multiple choice test that the physician can answer and

> mail back to get CME credit (continuing medical education).

> >

> > (Of course, the answers to the questions are also included.)

> >

> > I have a copy of the video and have made copies for parents who

> have a

> > hearing before an Administrative Law Judge (ALJ) because it is a

> great demonstration of the marketing techniques used to influence

> physicians and is such an outstanding case in point of today's

> ludicrous medical decision making.

> >

> > Most pediatric neurologists have either administered or prescribed

> > botox, which is derived from the most poisonous substance on the

> planet--botulin toxin. This is the very same stuff used to create

> Weapons of Mass Destruction, which by the way, a recent war was

> fought in an effort to eliminate botulin toxin.

> >

> > This war was fought and won by the very same United States

> government

> > who carried into battle hyperbaric chambers--just in case they ran

> into some botox. See

> > http://ihausa.org/newsletter/htm/aug_2002/page_1.htm .

> >

> > (Because you see, off-label High-Dosage Oxygen Therapy can

> detoxify a

> > person who's gotten too much botulin. There's a paper on this at

> medicaid/files/ .)

> >

> > (Is this crazy or what? The same government that prevents access

> to

> > off-label HDOT permits the off-label use of Botox, yet they're

> willing to wage war against massive off-label Botox--and use

> off-label HDOT in case they run tnto that same off-label Botox--yet

> the most fragile among us, our brain-injured children, they're more

> than willing to subject to and inject with off-label Botox and deny

> HDOT.)

> >

> > Anyway, when you get to the hearing, you ask the state witnesses

> if

> > they prescribe the off-label use of Botox, and when they say yes,

> and then you ask them why and ask if they're aware of the dangers,

> and that wars have been fought to prevent the off-label

> administration of botulin toxin, and then you whip out this botox

> video and show it and enter it into evidence and make a huge dent in

> the judge's thinking into just how medical decision making is done

> in pediatric medicine.

> >

> > Next, you can then ask this very same witness/physician if he/she

> > would prescribe High-Dosage Oxygen Therapy and he/she will then also

> testify that (incredibly) it's too dangerous to prescribe the one

> substance that none of us can live without.

> >

> > It's also helpful to first set up the witness(es) by asking if

> they

> > ever use the Physician's Desk Reference (PDR), a 15-pound book that

> is a compilation of all the labels and literature inserts of every

> FDA-approved drug. They have these things in every library and most

> doctors have 3 or 4 extras lying around. You ask the doc their

> opinion of the PDR and most will describe it as their " bible. "

> >

> > Then you let them say things like " it's my best resource " and

> " it's

> > the best authority. " Then ask them to look up things prescribed for

> your child and there's a greater than 90% chance the PDR will say

> " not FDA approved for pediatric use. "

> >

> > Then, once the witness(es) testify that prescribing extra oxygen

> is

> > too dangerous, have them look up " hyperbaric " in the PDR.

> >

> > They won't find it.

> >

> > Then ask them to look up " oxygen. "

> >

> > It's not in there either.

> >

> > So then you or your attorney asks how they can make a decision to

> deny

> > High-Dosage Oxygen Therapy when there's no reference to it in their

> " best authority " --yet they are willing to prescribe a substance

> off-label, where the off-label use of the same substance has caused

> a war to be fought and people have died?

> >

> > I'm sure there are even more homeruns that can be hit with this

> > comparison, but the point that needs to be made is that medical

> decision making in pediatrics is more a matter of successful

> marketing than science.

> >

> > You can use any commonly precscribed off-label drug to illustrate

> the

> > point; however, botox works well since there is this video out there

> with CME credit and a recent war has been fought to prevent the

> off-label use of botulin toxin.

> >

> > I think the botox example just further drives home the point of

> how

> > ridiculous this all is and will help the ALJ " see " what's really

> going on here.

> >

> > We have another ALJ hearing soon, and I certainly intend to enter

> the

> > botox video into evidence as a demonstration of how there's no one

> around to spend millions on advertising High-Dosage Oxygen Therapy

> since they'll never see a return because there is nothing to patent.

> >

> > ```````````````````````````````````````````````````````

> > " Rarely do we find men who willingly engage in hard, solid

> thinking.

> > There is an almost universal quest for easy answers and half-baked

> solutions. "

> >

> > --The Reverend Luther

> King,

> > Jr.

> >

> > ```````````````````````````````````````````````````````

> >

> > Freels

> > 2948 Windfield Circle

> > Tucker, GA 30084-6714

> > 770/491-6776 (phone and fax)

> > 707/220-7224 (efax, sends fax as email attachment)

> > mailto:dfreels@...

> >

> > http://www.freelanceforum.org/df

> >

July 2, 2003

The reimbursement for HBOT at a hospital is not $1000. Physician

supervision is around $100 plus or minus. The technical component is

currently set at $162ish for every 30 minutes. While they can't charge

you a different price from an insurance patient, they can, on humanitarian

grounds, just not charge you for the technical component, for example. I

am almost certain they can waive a charge - they just can't have different

charges for different patients.

KP Stoller, MD, FAAP

Assistant Clinical Prof, UNM HSC Dept Pediatrics

Simply Hyperbarics

www.simplyhyperbarics.com

>

>> THe hospital based HBOT units a run by those that feel they will be

>> breaking a rule and therefore jeopordize reimbursement if they treat

>> off-label indications. THere is no such rule!

>>

>> KP Stoller, MD, FAAP

>> Assistant Clinical Prof, UNM HSC Dept Pediatrics

>> Simply Hyperbarics

>> www.simplyhyperbarics.com

>

> ==================

>

> Dr. Stoller, this was my first thought also. However, I've been todl

> that the problem comes in in how much is charged. For example, the

> charge billed by our local hospital's chamber to insurance, Medicaid,

> Medicare, etc. for " approved " indications is somewhere over $1000 per

> treatment. That means that if, by some miracle, they agreed to treat

> my son's brain injury, they would have to charge me that same prive for

> each treatment to my son or risk being charged with

> Medicaid/Medicare fraud. At that point, even if I wanted to have my

> son treated in their chamber, they've precluded themselves on the price

> issue alone.

>

> Lynn

>

> _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

> Join the International Hyperbaric Medical Association

> http://www.hyperbaricmedicalassociation.org/forms/Friends_of_IHMA_Join.pdf

>

> Unrestricted downloads of 50+ pdf files on HBOT efficacy

> medicaid/files/ ,

> HDO-documentation/files/ and

> http://www.drneubauerhbo.com/papers.htm

>

> Download your state EPSDT program

> http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on the

> word " ameliorate " . State Medicaid websites

> http://www.medi-cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver

> programs: http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

>

> Find a hyperbaric clinic http://www.netnet.net/mums/hbolist.htm

>

> HBOT can save billions of dollars and millions of heartaches. Subscribe

> to by sending a blank email to

> mailto:medicaid-subscribe

>

> Unsubscribe? Click here

> mailto:medicaid-unsubscribe .

>

July 2, 2003

> > , as I have explained in my previous e-mails, our hospital,

our docs and our insurance are all owned by the same company. We are

submitting a request to the insurance company to be reimbursed for my

son's HBOT - we fully expect it will denied, either because they

consider HBOT to be experimental or because we used an out-of-plan

provider. < <

There has been a new development in our situation and I am curious to

hear thoughts from folks who've had experience in fighting for

reimbursement from their insurance companies. I just got off the

phone with the medical director of our insurance plan. He advised me

that it is very possible that our claim will be denied not because

they consider HBOT experimental or even because we used an out of

plan provider - instead, it may be denied because " therapy, treatment

or services for developmental/learning disability or delay " are

directly excluded from our policy. The definition of

developmental/learning disability or delay is defined as " a condition

that interrupts or delays the sequence and rate of normal growth,

development and maturation that may be due to: 1) congenital

abnormality; or 2) trauma; or 3) Deprivation; or 4) disease. " We

have said we sought HBOT for my son to help resolve his global

developmental delays that are likely a result of his PVL (a

congenital abnormality or disease?); therefore, under our policy,

that would be excluded.

Thoughts?

Lynn

July 2, 2003

THere you have it. A policy that directly excludes neuro-rehab. Now, how

do you think that came into being?

KP Stoller, MD, FAAP

Assistant Clinical Prof, UNM HSC Dept Pediatrics

Simply Hyperbarics

www.simplyhyperbarics.com

>

>> > , as I have explained in my previous e-mails, our hospital,

> our docs and our insurance are all owned by the same company. We are

> submitting a request to the insurance company to be reimbursed for my

> son's HBOT - we fully expect it will denied, either because they

> consider HBOT to be experimental or because we used an out-of-plan

> provider. < <

>

> There has been a new development in our situation and I am curious to

> hear thoughts from folks who've had experience in fighting for

> reimbursement from their insurance companies. I just got off the phone

> with the medical director of our insurance plan. He advised me that it

> is very possible that our claim will be denied not because they

> consider HBOT experimental or even because we used an out of plan

> provider - instead, it may be denied because " therapy, treatment or

> services for developmental/learning disability or delay " are

> directly excluded from our policy. The definition of

> developmental/learning disability or delay is defined as " a condition

> that interrupts or delays the sequence and rate of normal growth,

> development and maturation that may be due to: 1) congenital

> abnormality; or 2) trauma; or 3) Deprivation; or 4) disease. " We have

> said we sought HBOT for my son to help resolve his global

> developmental delays that are likely a result of his PVL (a

> congenital abnormality or disease?); therefore, under our policy, that

> would be excluded.

>

> Thoughts?

>

> Lynn

>

> _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

> Join the International Hyperbaric Medical Association

> http://www.hyperbaricmedicalassociation.org/forms/Friends_of_IHMA_Join.pdf

>

> Unrestricted downloads of 50+ pdf files on HBOT efficacy

> medicaid/files/ ,

> HDO-documentation/files/ and

> http://www.drneubauerhbo.com/papers.htm

>

> Download your state EPSDT program

> http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on the

> word " ameliorate " . State Medicaid websites

> http://www.medi-cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver

> programs: http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

>

> Find a hyperbaric clinic http://www.netnet.net/mums/hbolist.htm

>

> HBOT can save billions of dollars and millions of heartaches. Subscribe

> to by sending a blank email to

> mailto:medicaid-subscribe

>

> Unsubscribe? Click here

> mailto:medicaid-unsubscribe .

>

July 2, 2003

RE: neuro-rehab.

This is the core problem that the Texas law was supposed to overcome. And

remains the core problem in AMERICAN medicine. And, this is one of my core

pursuits to reverse this fraudulent quagmire.

The issue is many AMERICAN neurologists still do not believe in neuro

plasticity (Hubble & Weisel won their Nobel Prize in Medicine for their

work in 1960's 1970's on demonstrating plasticity).... a long forgone

conclusion.

And, they do not believe in the reversibility of the ischemic penumbra

(est. that is reversible for as long as 7 years post injury (1978)..... a

long foregone conclusion

They also believe that unexplained spontaneous recovery can only occur in

the first six months post injury, and beyond that nothing is possible for

these kids....... except when HBOT enables them to recover, it is a natural

and normal phenomena! A long foregone inaccuracy.

Finally, they do not believe CNS neurons develop or grow over our lifetime

(even the conservative NIH publicly announced that this is not true years ago!)

Thus, AMERICAN neurologist tend to be " see no evil, hear no evil, speak no

evil " in their approach to neurology. This position is well established

and easily seen at the AACPDM, farcical approach to medicine as well as the

self defeating " science " pursued by the UCP.

Some of this will be coming out in 2 months in the DVD that is being

completed featuring the Int'l Congress of HBOT Medicine's debate on Ped. HBOT.

Best Wishes,

Ed Nemeth

At 12:27 PM 7/2/2003, you wrote:

>THere you have it. A policy that directly excludes neuro-rehab. Now, how

>do you think that came into being?

>

>KP Stoller, MD, FAAP

>Assistant Clinical Prof, UNM HSC Dept Pediatrics

>Simply Hyperbarics

>www.simplyhyperbarics.com

>

> >

> >> > , as I have explained in my previous e-mails, our hospital,

> > our docs and our insurance are all owned by the same company. We are

> > submitting a request to the insurance company to be reimbursed for my

> > son's HBOT - we fully expect it will denied, either because they

> > consider HBOT to be experimental or because we used an out-of-plan

> > provider. < <

> >

> > There has been a new development in our situation and I am curious to

> > hear thoughts from folks who've had experience in fighting for

> > reimbursement from their insurance companies. I just got off the phone

> > with the medical director of our insurance plan. He advised me that it

> > is very possible that our claim will be denied not because they

> > consider HBOT experimental or even because we used an out of plan

> > provider - instead, it may be denied because " therapy, treatment or

> > services for developmental/learning disability or delay " are

> > directly excluded from our policy. The definition of

> > developmental/learning disability or delay is defined as " a condition

> > that interrupts or delays the sequence and rate of normal growth,

> > development and maturation that may be due to: 1) congenital

> > abnormality; or 2) trauma; or 3) Deprivation; or 4) disease. " We have

> > said we sought HBOT for my son to help resolve his global

> > developmental delays that are likely a result of his PVL (a

> > congenital abnormality or disease?); therefore, under our policy, that

> > would be excluded.

> >

> > Thoughts?

> >

> > Lynn

> >

> > _._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._._.

> > Join the International Hyperbaric Medical Association

> > http://www.hyperbaricmedicalassociation.org/forms/Friends_of_IHMA_Join.pdf

> >

> > Unrestricted downloads of 50+ pdf files on HBOT efficacy

> > medicaid/files/ ,

> > HDO-documentation/files/ and

> > http://www.drneubauerhbo.com/papers.htm

> >

> > Download your state EPSDT program

> > http://www.hcfa.gov/medicaid/stateplan/Map.asp by doing a search on the

> > word " ameliorate " . State Medicaid websites

> > http://www.medi-cal.ca.gov/RelSites_Oth_States.asp . Medicaid waiver

> > programs: http://www.geocities.com/HotSprings/Villa/1029/medicaid.html

> >

> > Find a hyperbaric clinic http://www.netnet.net/mums/hbolist.htm

> >

> > HBOT can save billions of dollars and millions of heartaches. Subscribe

> > to by sending a blank email to

> > mailto:medicaid-subscribe

> >

> > Unsubscribe? Click here

> > mailto:medicaid-unsubscribe .

> >

July 2, 2003

I will get right on it!!! Thanks for the plan of action. I will let you know

how it goes!!