Federal and State law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically.
This directive looks to have been hand-written by 'special interests' for the specific purpose of the type of discrimination we are seeing. I think the Academy of Neurologists has drawn its line in the sand, with a clear effect on the ability to afford treatment, the productive life of the population, and on the incomes of other physicians who are treating legitimate human health problems with real consequences on human suffering and reduction of harm. It is now up to other, competing, interest groups or those being discriminated against, or their representatives, to either shut down this despicable effort, or have the flow of income supporting this humane and proper work shut off at the source.
The fact that these people being treated have been (mis)diagosed as having 'Multiple Sclerosis' has no bearing on their need for this treatment. These treatments are being denied for two reasons: to preserve the fictions and theories surrounding the neurology profession's traditional domination of a patient population and this segment of the very lucrative drug industry which has been constructed to support it, and to avoid billing of legitimate claims for necessary medical treatments which result in improved human health, quality of life, and continued employment.
The fact that these orders are all worded similarly, and appeal to the sentimental tradition of the so-called 'MS Society' is extremely divisive of the more vulnerable of these people, causing them even worse stress and harm. The 'Society' has taken on the mission to spend large amounts of human and financial resources, in an effort to slow or prevent the progress of this treatment, because of its deep ties to the drug industry and the neurology profession, which has recently come under the harsh shadow of a kickback scandal concerning 'MS' drugs, also paid for by the same insurance industry, and seen by those doctors as competing with these vascular treatments. The opinions of this 'Society' are not unbiased.
The references quoted are carefully chosen from among many available papers on the subject to support the opinions of the bulletin and oppose the carefully chosen 'counter-evidence'. If other references were quoted, an entirely different, and more truthful picture would emerge.
The action of this memo is discrimination on the basis of previously existing illness and on widely disputed medical opinion.