Related article: Cost of the Marshall Protocol
Related article: Cost of the Marshall Protocol
In the United States, private insurance coverage varies widely. Federally-funded and state-funded plans also vary in their coverage. Unfortunately for Marshall Protocol (MP) patients, insurance companies have a strong motivation to refuse coverage: an economic one.
It has been the experience of MP patients that getting full coverage for Benicar three to four times daily has posed the most serious problem. Whenever calling an insurance company, patients should expect excellent service but not be too surprised when they do not get it. This can be very frustrating. In fighting a claim denial, patients should be persistent, professional, and well-organized.
In time, as more studies are published about the Marshall Protocol, insurance companies' denial of Benicar promises to be a thing of the past.
There is no substitute for olmesartan (Benicar). Be sure to have an adequate supply in case coverage is denied.
Expense | Covered by insurance? |
---|---|
Doctors visits | Typically, yes. Covered by insurance with the usual deductible and co-pay stipulations. These visits do not need to be frequent. Many doctors encourage their patients to get routine information and support from our websites. Other routine labwork to monitor organ function is usually covered by insurance. |
Olmesartan (Benicar) | Varies |
Test of vitamin D metabolites | Typically, yes. For full coverage, be sure to use the appropriate codes. |
Other labwork | Typically, yes. |
Marshall Protocol antibiotics | Typically, yes. Antibiotics can be ordered as a generic or not, and at the standard dosage and schedule without question to maximize one's insurance benefit. Because they are taken at a lower dose and pulsed, they will last a much longer time. The doctor's instructions can simply say “take as directed.” |
NoIRSpecial sunglasses worn by Marshall Protocol patients to block light. or other recommended sunglasses | Typically, no. |
Thousands of patients have used the Marshall Protocol. It has an excellent record both in terms of safety and efficacy, as evidenced by the numerous patients reporting symptom remission.
Insurers who deny coverage for Benicar are denying medical care, a care that has the very real potential to cure a patient's disease. It is worth fighting for the full insurance benefit because Benicar is a fairly expensive medication. Brand-name Benicar can be $1,200 or more a year – although the generic equivalent can be purchased for a great deal less.
What may be especially frustrating about the denial of Benicar is how it is much cheaper than any number of palliative medications that make the disease worse: anti-TNF-alphaA cytokine critical for effective immune surveillance and is required for proper proliferation and function of immune cells. drugs, interferon, corticosteroids, etc. One's insurance company may be too short-sighted to see this, but going on the MP will reduce the cost of medical care over the long-term.
According to a statement by the FDA, “Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment.”
It is the doctor who has the license to practice medicine – not the insurance company! With the consent of the patient, it is the doctor's right and responsibility to decide which therapies a patient receives. If a doctor is williing to accept responsibility for the way he or she practices medicine, an insurance company has no right to interfere.
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Sometimes an insurance company will balk at covering higher than customary doses of Benicar. If so, patients may need to challenge that decision and/or file an appeal, a process which can take several weeks or months. All insurers have an appeal process for claims that are denied. The following steps are typical in an appeal:
Most insurance companies will only accepted peer-reviewed papers demonstrating the safety or efficacy of Benicar. For information on Benicar's safety, consult the relevant article. There are a number of studies mentioned. Two good papers to refer to are Schwocho and Brunner.
Efficacy of Benicar has been described in various conditions by a forthcoming peer-reviewed paper in Annals of the New York Academy of Sciences. That paper will be available in the Fall of 2009. For a preprint – or for any other paper – ask on the MP study site.
Main article: Letters to present to an insurance company
Generally speaking, most Marshall Protocol (MP) patients find that the MP antibiotics are covered by their health insurance. Sometimes, however, an insurance company will balk at covering the higher-than-usual dosage of olmesartan (Benicar). Patients who are denied coverage for the dose of olmesartan (Benicar) that the MP requires have the right to appeal that decision.
An MP patient's physician may need to write a “Letter of Medical Necessity” to the insurance company in order to help the patient obtain needed coverage. Below are form letters that a patient or his/her physician may find convenient to use. These letters contain information that has helped some MP patients obtain insurance coverage for the full dose of olmesartan (Benicar).
Patients may want to include printouts of Knowledge Base articles that discuss the safety and efficacy of olmesartan (Benicar).
Main article: Ordering olmesartan (Benicar)