Sculptra Medical Necessity Letter from Dr Frechette

[Guest guest]

Gervais Frechette M.D, P.C

55 Street

Suite #1

New York NY 10014

GERVAISFRECHETTE@...

Dec 1, 2004

Benefit Concepts Incorporated

RE: Group Name:

Group Number:

To Whom It May Concern:

My patient has been HIV positive for approximately seven years. Procedure #11952 is indicated to reconstruct his face, with Sculptra (product 99070), which has suffered from the effects of lypodystrophy (in his case facial wasting), a syndrome developed because of the effect of the anti-viral medications that he needs to take on a daily basis and HIV disease.

The condition has rendered his face severely gaunt and drawn. When he attempts to shave his beard, he often gets nicks and cuts and also suffers from lesions from biting his cheeks.

On several occasions, he has considered ending his antiviral medications because of the obvious side effects. With very high viral load there is great risk and absence of HAART would create many additional medical issues.

Psychiatric counseling will be expedient if his self-esteem and social withdrawal issues are not properly addressed through appropriate and significant facial restoration/reconstruction with the injectable device, Sculptra.

The procedure indicated on his claim treats this disfiguration. His claims should not be considered cosmetic but rather analogous to reconstructive remedies for burn, cancer or accident victims, and necessary in order for Mr. to continue to lead a normal and healthy life. The emotional impact of facial lipoatrophy is of particular concern since this is what most readily see and identify as a condition related to HIV infection. SCULPTRA / NEW-FILL is the only treatment approved by the FDA to improved facial lipoatrophy.

The diagnosis codes are 042 HIV and 272.6 HIV-related lipodystrophy syndrome consist of lipohypertrophy (fat accumulation in the visceral area and dorsocervical pad) and lipoatrophy (subcutaneous fat loss in the face, extremities and buttocks).

Procedure code is 11952 and 99070 is for the supply (SCULPTRA /New-Fill).

As this approval is relatively recent, I would be more than happy to further educate your company on this issue in any way that you might deem helpful.

Should you have any further questions, please contact me at the above telephone number or e-mail address that the patient cannot afford. Your prompt attention this matter would be greatly appreciated.

Sincerely,

Dr. Gervais Frechette

cc: Complaint Commissioner for Health Insurance in New York State

VergelDirectorProgram for Wellness Restoration, PoWeRA 501 © 3 non profit national organizationLinks to our web sites:www.nelsonvergel.comwww.powerusa.orgwww.facialwasting.orgwww.salvagetherapies.orgJoin our free listservers by sending a blank email to:pozhealth-subscribe fuzeonsupport-subscribe DisclaimerThis information (and any accompanying printed material) is not intended to replace the attention or advice of a physician or other health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a qualified health care professional.