Sunday, June 19, 2016

Letters to the Medical Directors of the Medicaid Pharmacy Benefits Insurance Companies About Their Refusing to Pay for Alpha Stim Treatment

I had a trouble finding their mailing addresses, not readily available on any of their websites.

I am therefore listing them here, along with the letter their Medical Directors were sent.

RE: Paying for Alpha Stim without Pre-Authorization

Dear Doctor,
Alpha Stim is an FDA approved Class II medical device, as a condom is classified.  It has FDA approved indications for depression, anxiety, insomnia or pain. It requires a prescription in the United States.

The device is reviewed here:

It has the pain management potential to solve the opioid overdose problem. To continue to refuse to pay for it is cruel to extremely distressed patients and unconscionable. It is also stupid. Spend $hundreds on it, save $thousands on medications that can be weaned off and discontinued.

If you pay for other medically indicated FDA approved, medical device of any kind, you must pay for Alpha Stim without a pre-authorization requirement. The Affordable Care Act (ACA) prohibits discrimination against mental health treatment.  I am attaching printed guidance from CMS on the Mental Health Parity provision of the ACA.

If you continue to refuse to fund Alpha Stim treatment, including all necessary accessories, I will be asking the federal prosecutor and the Office of Civil rights to enforce the federal law in federal court. As is my legal duty in Pennsylvania, I will also be initiating regulatory complaints against you personally. Your brazen violation of federal laws is unprofessional conduct.

UPMC Health Plan; U.S. Steel Tower; 600 Grant Street; Pittsburgh, PA 15219

Keystone First; 200 Stevens Dr. ; Philadelphia, PA 19113; Phone:(215) 937-8000

Health Partners; 901 Market St #500; Philadelphia, PA 19107

John B. Bulger, DO, MBA, Medical Director; Geisinger Health Plan Insurance Agency;
108 Woodbine Ln; Danville, PA 17821; Phone:(570) 271-8771

Gateway HealthSM; Four Gateway Center; 444 Liberty Avenue, Suite 2100; Pittsburgh, PA 15222-1222

AmeriHealth Caritas Pennsylvania; 8040 Carlson Drive; Suite 500; Harrisburg, PA 17112

Aetna Better Health Administrative Office; Aetna Better Health; 2000 Market Street, Suite 850
Philadelphia, PA 19103;  1-866-638-1232;  (HealthChoices)

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