Re: Can federal health plans be legally compelled to cover (or consider covering

[Guest guest]

Hi Randall,

Reading your note reminded me that I know someone who has recently

become the director of a major disability law center. I think he's

just started and busy, but I'll put a call into him when it feels

right and let you know what I discover (if anything).

I've been skeptical these days about any new services being added. Our

current administration has been covertly slashing section 8 for

several years. Regarding health care, Congress won't take steps to

reduce costs (e.g. the new Medicare prescription drug plan didn't

entail any negotiating with drug companies who make 80% profit margins

and have mighty strong lobbyists). (I hope I'm not getting too

political for this group!!). Still, why not look into it?

I don't know what state you live in but some states have enough

resources to consider bills to expand Medicaid coverage on the state

level. As I mentioned, we tried it here in Mass and it might have

worked if the larger health care bill hadn't over-rode all the smaller

ones.

Best,

Shayna

>

> Any lawyers here? Wondering if there might be a way to convince or

compel health insurance plans - particularly federal plans, like

Medicare, Medicaid, the Federal Employee plans, etc. - to cover some

of the cost of CoQ10 and maybe some other supplements recommended for

Mito. My thinking is that in a situation where someone has a

significant disease, for which there is no prescription drug or other

billable treatment, but a specialist recommends an over-the-counter

supplement like CoQ10 as a treatment, insurance plans should cover

some of the cost. I'm wondering if these plans or their contracts

with or requirements from the government have language to the effect

that there can or should be coverage in such a situation or that the

enrollee can petition for an exception to non-coverage policy in such

a situation. Also wondering if any of these plans have language or

requirements from the government that they can or should cover

supplements that have orphan drug status for the disease or condition

in question. I'm wondering this since a few of you have mentioned

that federal plans, including Tricare, some state Medicaid plans and

Blue Cross, sometimes do cover some of the costs for CoQ10. It seems

there should have been a provision to cover a situation like this in

the new Medicare Rx plan, but since it was mainly written for the

benefit of the drug companies, would not be surprising if this wasn't

even considered.

>

> I am putting this question in writing to my Congressman after

talking to his aide on health care, per her suggestion. But I'm

wondering if there are any possible legal avenues here.

>

> Will always take free legal advice, so thanks in advance!

>

> Randall

>

>