Research info backing Redlabs for my ins. company

Discussion in 'Fibromyalgia Main Forum' started by simonedb, Jan 13, 2010.

  1. simonedb

    simonedb Member

    Hi, my evil ins. co. denied my redlabs (now VIP) claim for the full cfs panel, looks at rnase l, nkc, dysbiosis etc
    I even had my regular mainstream doc at a respected institution order it and write a letter of med necessity but they denied it 2x, and now I am appealing it, the last step. I need to supply them with research showing why its medically necessary and valid as they denied it based on it being "experimental". If anyone has studies, links to papers etc that support getting that test please send them my way. One thing I am confused about, is if there isnt really a standard protocol for treating cfids in the u.s. but yet it is a valid diagnosis that ins. will sometimes cover some tests for, well, how does one get around their sneaky angle of calling it experimental? I will send them literature showing that some recognized docs use this protocol of redlabs labs etc but its not the standard of care thats accepted I know....
    Its happening at the end of the month.
  2. quanked

    quanked Member

    my understanding is that there has NOT yet been a standardized test developed yet--if you are talking about testing for XMRV. Last I heard is that a test should be available to the public time this year.

    I am not sure what this means, given that the study done by WPI is being recognized as a valid reasearch study. Not sure why their test cannot be used but I am not a medical researcher and I know so little.

    I am sure that you will get some much more informed responses as the evening passes.
  3. simonedb

    simonedb Member

    A year ago they were calling it their full cfs panel test
    NOw I don't know what they call it since xmrv, but I also cannot find their website whereas last year they had a site that named and described all their tests
  4. victoria

    victoria New Member

    I'd think that their website might be down for re-design or similar reason - have you tried calling them?

    I would keep at the insurance, even call your state insurance comm., plus your state & federal reps, whomever/whatever.

    The reason I say this is because exceptions are made all the time, but usually for political or 'personal' reasons.

    My DH used to be a psychologist, a certain big insurance co at first refused to pay for his psychological treatment of a severe anorexic/bulimic pt (she was about 85 lbs), but made an exception because the father of the pt was a 'very important person'.

    The company literally wrote my DH a letter telling him to never tell anyone they made an exception. Wish I'd saved it!

    So, keep at 'em!

    all the best,

  5. simonedb

    simonedb Member

    thx victoria, that is what I suspected, but I don't know how to fight against that as no bigshots alive in my life right now :)
    I did say I was going to complain to my employer ( a big institution) and call the ins.commission, will put togetehr my rebuttal with some help and if they deny it again I may talk to an attorney just on principle since medicaid pays for the test as does an hmo in my county and its what a lot of respected cfs docs use in the country so they are behind the times....