(no subject)
So, who wants the latest insurance company story to make their blood boil?
Here's the basics: there's a genetic condition called Prader-Willi syndrome. It causes a whole slew of problems, one of which is hypotonia, or muscle weakness. Growth hormone is prescribed for this problem. It's FDA approved and insurance formulary; one of the few diagnoses for which we almost never have trouble getting growth hormone approved by the insurance company.
We have a patient with a chromosomal abnormality which is very similar, but not quite, PWS. They're having hypotonia. Same problem.
Here's the actual response, verbatim, from the insurance company:
"Your request for NUTROPIN AQ 10MG has been denied. The reason for the denial is that: The included diagnoses are very specific. To approve for a non designated condition for muscle strengthening whereas there might be some beneficial effect could open the floodgates of administration to all sorts of conditions for which "muscle strengthening" might have some value."
So... correct me if I'm wrong here, but the insurance company seems to be making two major points here, with one conclusion:
1) Growth hormone would help your patient.
2) It would therefore probably also help other patients with the same problem.
Therefore: We will not pay for it.
.....srsly. WTF.
Here's the basics: there's a genetic condition called Prader-Willi syndrome. It causes a whole slew of problems, one of which is hypotonia, or muscle weakness. Growth hormone is prescribed for this problem. It's FDA approved and insurance formulary; one of the few diagnoses for which we almost never have trouble getting growth hormone approved by the insurance company.
We have a patient with a chromosomal abnormality which is very similar, but not quite, PWS. They're having hypotonia. Same problem.
Here's the actual response, verbatim, from the insurance company:
"Your request for NUTROPIN AQ 10MG has been denied. The reason for the denial is that: The included diagnoses are very specific. To approve for a non designated condition for muscle strengthening whereas there might be some beneficial effect could open the floodgates of administration to all sorts of conditions for which "muscle strengthening" might have some value."
So... correct me if I'm wrong here, but the insurance company seems to be making two major points here, with one conclusion:
1) Growth hormone would help your patient.
2) It would therefore probably also help other patients with the same problem.
Therefore: We will not pay for it.
.....srsly. WTF.