Blue Cross assessment of LD and their medical admission of all three stages SAVE AND FAX TO BCBS or your local investigative scam reporter

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INCLUDING RECOMMENDED TREATMENT FROM 1990!!!!!!!!!!----- Forwarded Message ----To: dclaesson@...Sent: Thu, February 17, 2011 10:45:38 AMSubject: Fw: AH HA! I found it! SAVE AND FAX TO BCBS

Subject: Fw: AH HA! I found it! SAVE AND FAX TO BCBSTo: dclaesson@...Date: Thursday, February 17, 2011, 3:42 PM

A fellow lyme patient found this from Blue Cross and Blue Shield, and it sounds drastically different from what they actually do......

LymeNet Law PagesCase History DocumentLogan, et al V Empire Blue Cross and Blue ShieldEntered By: Ira M Maurer/LymeNet Date Created: 2-15-98Document Type: OtherTitle:Empire Blue Cross And Blue Shield Managed Care Medical Guideline:Treatment of Lyme Disease dated 10-1-90The following document was obtained during a recent pre-trialdeposition of an in-house doctor employed by Empire Blue Cross and BlueShield. The document reveals a far more reasonable and fairer approachto Lyme Disease back in 1990.EMPIRE BLUE CROSS AND BLUE SHIELDMANAGED CARE MEDICAL GUIDELINETOPIC: Lyme disease, Lyme borreliosis or borreliosis, is a recentlyrecognized sphirochetal infection. It is transmitted to humans byIxodid ticks. Evidence indicates that the disease may have been presentin this country for many years; it is also found worldwide. There hasbeen discussion as to the need

for hospitalization of patients whorequire IV therapy. An alternative procedure has been promoted for homeIVtreatment. The present guideline addresses this issue.BACKGROUND: As with syphilis, findings of Lyme borreliosis have beendivided into 3 stages. Stage I (acute) is manifested by a spreadingskin lesion (erythema migrans), a flu-like illness, regionallymphadenopathy or absence of these signs. Stage II (subacute) includesmore extensive skin involvement, musculoskeletal/joint pain, andneuropathic entities, such as meningitis, encephalitis, mono-orpolyradiculapathy (Bell's palsy bilateral), cardiac involvement (A-Vnodal block), pancarditis, panophthalimitis, ARDS, hepatitis, andorchitis. Constitutional symptoms of malaise and fatigue are prominent.Stage III (chronic) disease includes chronic prolonged arthritis,keratitis, indolent acrodermatitis with or without periostitis or jointsubluxation,

chronic neurological syndromes (ataxic gait, paraparesis,psychological disturbances, dementia, encaphalomylitis,polyradiculopathy).The diagnosis of Lyme borreliosis is established by symptomatology,clinical findings and measurement of serum IgG and IgM antibodies, thelatter indicating recent onset. However, spirochetes can persist inbody tissues even with negative serum titres.Treatment of Stage I illness calls for oral antibiotics such asdoxycycline, tetracycline, amoxicillin (or erythromycin if the patientis penicillin-allergic). These are given for 10-30 days.Hospitalization is not warranted. Similarly, oral therapy is indicatedfor mild Stage II entities, i.e., headaches, (without meningeal signs),musculoskeletal pain, mild to moderate arthritis, radiculopathy such asBell's palsy, first degree A-V block as long as P-R interval is <0.3seconds.For Stage II and III, particularly

with involvement of vital organs(CNS, heart), hospitalization with IV antibiotics is indicated:Ceftriaxone (2 gms/day IV x10-21 days) Cefotaxime (2x3g/day IV x10days) or Penicillin (20-40 million units/day IV x10-21 days). In lessclinically urgent cases, office or home IV administration has beenrecommended. However, a number of patients experience Jarish-Herxheimerreactions; still others demonstrate allergy to their antibiotics. It iswarranted to admit patients with serious Stage II and III disease forat least 4-5 days for initiation of IV therapy. Thereafter, if nocomplications ensue and depending on their disease status, outpatientIVtherapy can follow. Treatment failures have occurred with allregimens, and retreatment may be necessary. Slow recovery from subacuteor chronic Borreliosis can take years, even after treatment. This maybe due to the natural history of the disease or treatment failure.

Itis known that autoimmune mechanisms in the later phases of theinfection prevent full response to antibiotics. As the present state ofknowledge expands, changes in diagnostic methodology and therapy willoccur.SUBMITTED BY: Weissman, M.D.APPROVED BY:MEDICAL DIRECTORMANAGED CARE PROGRAMS /S/ 10/1/90___________________-