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Tags: hyperbaric oxygen | bends | multiple sclerosis

Who Controls Medicine?

William Maxfield, M.D. By Monday, 02 March 2015 03:46 PM EST Current | Bio | Archive

Physicians with proper training are licensed to practice medicine in various states. This program has worked well for years.
However, there is now is another factor playing a role in the field of medicine: increasing control by insurance companies regarding the procedures they will approve and cover. 
This problem came to my attention recently because of a patient who has had problems breathing. Her physician ordered a new medication and put her on a nebulizer. But the insurance company did not approve the strength of the medication (though they did approve a weaker strength). 
This has not only caused a significant delay in the patient receiving treatment for shortness of breath, it also highlights the fact that insurance companies now have the ability to counteract or even cancel a doctor’s prescription. But of course, insurance companies are not licensed to practice medicine.
A number of years ago, a multiple sclerosis patient I was treating with hyperbaric oxygen therapy (HBOT) was turned down for reimbursement by Blue Cross Blue Shield. She sued the insurance company in Florida and won complete reimbursement for past treatments and the right to have further treatments covered. (She had shown significant clinical improvement in her MS with the hyperbaric oxygen therapy.) 
There is also a clause in the Medicare rules and regulations that says if a treatment can be proven to be beneficial, Medicare has to pay for it. Not everyone knows about it, but the clause is there in the rules. 
In the United States, we have 17 approved indications for hyperbaric oxygen therapy. In other countries, such as Russia, there are 73 indications for HBOT. For instance, if a woman in Russia has an abortion because of difficult pregnancy circumstances, the next time she becomes pregnant she is given HBOT in her third trimester. The majority of women given the treatment have normal, viable fetuses. 
Another indication for HBOT that is controlled by insurance companies is treatment of the bends, a decompression illness that can befall scuba divers when there is over-pressure and a quick release, causing air bubbles in the vascular system that can damage the brain. 
Experimental animal data out of Sweden show that exposure to machine gun fire and anti-tank fire is capable of producing the same type of air bubbles in the vascular system as the bends. Therefore, our service people should be able to receive HBOT for blast exposure.
Then, after hyperbaric oxygen has been used, a SPECT brain scan can objectively document the response to the treatment, confirming the clinical response that the patient shows.  
Yet we have not been able to convince insurance companies that blast exposure is a valid indication for SPECT brain scan or HBOT. 
Hopefully, the control of medicine by the insurance companies, which are not licensed to practice medicine, will change. I suggest you contact your representatives in the state and federal government to point out any problems you have encountered in getting the treatment that your physician has recommended. 

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Hopefully, the control of medicine by the insurance companies, which are not licensed to practice medicine, will change.
hyperbaric oxygen, bends, multiple sclerosis
Monday, 02 March 2015 03:46 PM
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