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Letters to present to an insurance company

Generally speaking, most Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (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)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor.. 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).

Generic letter of medical necessity from an MP physician

To Whom It May Concern:

[Name of patient] is my patient, and is currently under my care for [name of Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens.]. I have prescribed Benicar, an Angiotensin II Receptor Blocker, at 40mg every six hours.

Patients with this condition have a dysregulated Vitamin D metabolism, which causes abnormally high levels of the active metabolite 1,25 dihydroxyvitamin D. This results in chronic inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue., which prevents the immune system from attacking the pleomorphic pathogens that trigger this hypervitaminosis D.

By blocking the angiotensin receptor sites, Benicar reduces the level of 1,25-DPrimary biologically active vitamin D hormone. Activates the vitamin D nuclear receptor. Produced by hydroxylation of 25-D. Also known as 1,25-dihydroxycholecalciferol, 1,25-hydroxyvitamin D and calcitirol. dramatically and provides an inflammatory blockade which allows the immune system to function normally. This also potentiates the use of low-dose antibiotics to eliminate pathogenic bacteria that are the underlying cause of this disease process.

Patients with inflammatory disease have many additional angiotensin II receptors in their inflamed tissues, and they all need to be blocked to provide an adequate anti-inflammatory effect.

This inflammatory blockade only works if an adequate blood level of Benicar is maintained by dosing every six to eight hours. Therefore, the dosage has to be individualized (in full accordance with the labeling) in order for the drug to achieve this effect.

FDA guidelines allow this dosing, and this medication does not work effectively for this purpose at a lower dosage.

No other ARBA drug which is an angiotensin receptor blocker. One of the ARBs is olmesartan (Benicar). Not all ARBs activate the Vitamin D Receptor. (angiotensin receptor blocker) is adequate to substitute for Benicar (olmesartan)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor., as olmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. alone performs the specific actions needed to also act upon the vitamin D receptorA nuclear receptor located throughout the body that plays a key role in the innate immune response. and fully enable the immune system.

Thank you for your consideration in this matter.

Sincerely,

[Name of MP physician]

Additional diagnosis of hypertension can be helpful

If the patient fits the criteria for diagnosis of hypertension – the FDA approved indication – and if a patient does not respond adequately to one 40mg tablet a day, patient may want to note that the FDA's monograph for Benicar says: “dosage must be individualized.”

The prescribing information, which contains those instructions are available from the FDA's website.

Letter responding to claim denied on the basis of safety

To Whom It May Concern:

The use of an ARB for treating chronic disease is off-label, but the dosing is not “outside FDA approved guidelines,” which can be examined online at the FDA's website: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021286s020lbl.pdf

In fact, as you can see from the FDA's monograph for Benicar, there is no maximum safe dosage determined for the drug, only a dosage level based on efficacy in the hypotensive indication.

I am enclosing with this letter an article, which cites a number of peer-reviewed papers written by expert pharmacologists and researchers attesting the safety of Benicar. I do hope you take the time to investigate the research I am sharing. Once you do, I'm sure you will agree that there is conclusive evidence that Benicar is safe in the amount my doctor has chosen to prescribe me.

Thank you for your consideration.

Sincerely,

[Patient Name]

Letter explaining personal circumstances

Sometimes it helps if a patient can explain how the MP has helped.

To whom it may concern:

Since I now know what Medco's corporate position and answer is for the denial of my prescription refill, I'll give you some personal background information regarding the reason for the prescribed use of the drug Benicar in the treatment of my disease, and why I believe I have no choice but to continue to use this drug, even if it is 100% at my cost and procured through a local pharmacist.

After suffering from a variety of undiagnosed chronic inflammatory symptoms, chronic fatigue, and depression for years, I was formally diagnosed with sarcoidosis in May 2003 through the biopsy of an enlarged lymphnode in my chest. The long-term prognosis for sarcoidosis patients is grim, and my overall health and well being continued to decline. Historically, only the chronic symptoms of sarcoidosis are treated to provide some relief to the patient. I sought out these treatments through my pulmonologist and family physician, but realized after being scheduled for one more unnecessary CT, and the offer of narcotic pain relievers (both of which I declined), that I was going to have to take control of my health care if I was going to survive this ordeal.

In December 2004, while researching additional treatment options for sarcoidosis, my wife happened upon information regarding the Marshall Protocol. We researched the details and case histories of this protocol for a month, and in January 2005 I made the recommended life-style changes for diet and elimination of sun exposure. Within two months, I experienced symptomatic relief of some of my chronic pain. I then sought out a local physician for consultation, who had been treating other sarcoidosis patients with the Marshall Protocol with excellent results. Under my physician's care, I could then begin following the full protocol required for the cure.

Sarcoidosis patients have a dysregulated Vitamin D metabolism which causes abnormally high levels of the active metabolite 1,25 dihydroxyvitamin D. This results in chronic inflammation and prevents the immune system from killing the cell-dwelling pathogens that trigger the abnormal immune response.

By blocking the angiotensin receptor sites, Benicar reduces the level of 1,25-D dramatically and provides an inflammatory blockade which allows the immune system to function normally. This greatly potentiates the use of antibiotics that treat the underlying cause of the disease.

Studies have shown that sarcoidosis patients have additional Angiotensin II receptors in their inflammatory granuloma, and they all need to be blocked to provide an adequate anti-inflammatory effect.

This inflammatory blockade only works if an adequate blood level of Benicar is maintained by dosing every six to eight hours. Therefore, the Benicar dosage has to be individualized (in full accordance with the labeling) in order for the drug to be fully effective.

FDA guidelines allow this dosing, and this medication does not work effectively for this purpose at a lower dosage due to the sarcoid inflammation.

Even during the sometimes difficult healing process, my wife continues to remind me that she hasn't seen me this well in years, and she is correct. I've never been the type of employee to take a 'sick day' when I could be at work, even if less productive. I now know and feel like I will be an effective and high-performing employee for as long as I choose to be. I am nearing the completion of Phase 1 of the Marshal Protocol, and will be advancing on to Phase 2, with the introduction of additional antibiotics. Benicar is a critical pharmaceutical component of the Marshal Protocol, and unfortunately there are no formulary substitutes. Until there are, I will need to continue to purchase Benicar until my disease is cured, once and for all.

Sincerely,

[Patient]

References

home/mp/insurance/letters.txt · Last modified: 10.13.2018 by sallieq
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