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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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#1
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I just read Harrison's post in the Article Library, "Court Weighs Medical-Device Liability" and the blog links cited. The argument the lawyers for Medtronic and the federal government is that state laws and juries should not be allowed to overrule FDA's judgment:
"...the government said, Congress meant to shield companies from suits because approved medical devices meet reasonable safety and effectiveness standards that have benefits to some patients even though the device may also have risks. " Could this argument also be made with insurance companies when seeking coverage for ADR? LBP, other lawyers, what do you think?
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2001 MVA; C5-C6 disk extruded ongoing physical therapy, exercise and massage ESI's, oral prednisone, trigger point injections foraminal and central stenosis C5/C6 and c6/C7 2007 EMG/nerve conduction shows pattern of chronic radiculopathy January, 2008: Prestige ST Artificial Disk Replacement, C5/6 |
#2
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i do think every appeal to a private insurance company should absolutely present the FEHB Letter No 2001-27, via US Office of Personnel Management, Office of Insurance Programs, policy that states that once a drug or medical device is FDA approved it should no longer be considered "investigationals and experimental.
FEHB division that determines federal employee health insurance policy as it relates to the various private health insurance companies it contracts with. I don't think there should be a double standard applied by Blue Cross, or other private companies that offer some ins plans to private employees and other plans to federal employees and the fed employee get access to ADR when the private employees cant. But others have already posted the problem in fighting insurance companies...ERISA laws seem to preempt state law remedies for breach of contrat, bad faith claims ets.
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Injured 9/01 Annular tears L4/5 & L5/S1 denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5. New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop |
#3
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Thanks for your reply. Interesting that the last sentence in the letter presents the same argument:
Plans should not substitute their judgement for that of FDA concerning the appropriateness of use of FDA-approved products when they are used for FDA-approved intended purposes. On the theory that every bit of support might help and can't hurt, I am going to give this my best shot.
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2001 MVA; C5-C6 disk extruded ongoing physical therapy, exercise and massage ESI's, oral prednisone, trigger point injections foraminal and central stenosis C5/C6 and c6/C7 2007 EMG/nerve conduction shows pattern of chronic radiculopathy January, 2008: Prestige ST Artificial Disk Replacement, C5/6 |
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