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Sample E-mail to WellPoint
|Cut and paste the letter below into an e-mail and send it to Mr. Swedish and Dr. Nussbaum. You can personalize it if you want to:
via e-mail (email@example.com)
Mr. Joseph Swedish
Chief Executive Officer
120 Monument Circle
Indianapolis, IN 46204
via e-mail (firstname.lastname@example.org)
Samuel R. Nussbaum, M.D.
Chief Medical Officer
120 Monument Circle
Indianapolis, IN 46204
RE: WellPoint/Anthem Restrictions for Autonomic Testing
Dear Mr. Swedish and Dr. Nussbaum,
I am writing to request that WellPoint reconsider its recent decision to deny coverage for autonomic nervous system function testing for sudomotor function, cardiovagal innervation and vasomotor adrenergic innervations. Some of these tests ARE medically necessary to document autonomic dysfunction. Some of these tests (QSART, TST, SSR, and Valsalva) are necessary for proper diagnosis and treatment of diseases of the autonomic nervous system (dysautonomia), they ARE NOT investigational. There is no substitute to diagnose these conditions. Autonomic dysfunction causes a wide variation of symptoms and treatment must be tailored specifically to the symptoms unique to each patient. Without an accurate diagnosis, autonomic dysfunction cannot be effectively treated. The medical necessity of these tests has been well documented by the medical community for decades and has historically been covered by your policies without question.
Physicians from the American Academy of Neurology and the American Autonomic Society have registered their opposition to this misguided policy and have provided you with comments and suggestions for improvement. The rationale you provide in your Medical Policy on Autonomic Testing makes no sense, even to a lay person. WellPoint ignored the weight of the evidence and common sense in formulating its new Medical Policy on Autonomic Testing.
I suffer from ________________________, a form of dysautonomia. This condition can only be diagnosed, and other forms of autonomic dysfunction ruled out, through the tests that you are denying coverage for. Without an accurate diagnosis, I would continue to seek answers from doctor after doctor, continue to visit the emergency room when my symptoms are out of control, and continue to be subjected to unnecessary medical tests and procedures seeking answers to the cause of my symptoms. Failing to cover essential autonomic function tests for suspected autonomic disorders will result in increased costs to WellPoint's companies, and to patients who are already under financial strain due to their poor health.
Dysautonomia patients face a long and frustrating journey seeking a diagnosis. It is difficult to find a physician knowledgeable about and able to diagnose these conditions. Appointments must be scheduled sometimes six months to one year in advance. They must travel great distances to see one of the few autonomic experts in the United States. To then be confronted with the fact that their insurance will not cover the tests required by the autonomic expert is both emotionally and financially devastating. The quality of life of patients experiencing symptoms of autonomic dysfunction is extremely poor; the only hope of returning to a functional life is proper diagnosis and treatment. The physical, mental and financial toll of filing an appeal, along with the delay in diagnosis and treatment, can be devastating to a chronically ill patient.
What is the cost to you, the insurance company, to have an insured patient go undiagnosed? To have the patient continue to visit doctor upon doctor and be treated in the emergency rooms when symptoms are too severe? To have unnecessary and costly tests performed that will not provide information needed for effective treatment?
What options exist for the physicians treating these patients, many of whom have exhausted their financial resources just to reach the autonomic expert, if the only definitive tests, which have been in use for years, will not be covered by the patient's insurance company? There is NO reliable alternative to these tests.
WellPoint's new Medical Policy on Autonomic Testing (MED .00112) is a travesty that will prolong the pain and suffering of thousands of patients. I implore you to reconsider this policy.
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