HI DEBBY,

NO, UNFORTUNATELY INSURANCE DID NOT PAY ANYTHING TOWARD'S SARAH'S HYPERBARICS DESPITE THE FACT THAT I APPEALED TWICE. I WAS, HOWEVER, ENCOURAGED WHEN I RECENTLY READ THE FOLLOWING:

HEALTH CARE PLAN ORDERED TO PAY FOR HBO TREATMENT FOR CRPS PATIENT

NM Public Regulation Commission (PRC) orders health plan to pay for Hyperbaric Oxygen Therapy to treat 11 year old’s chronic pain syndrome

October 3, 2007

11-year-old Angel Sanchez triumphs over Presbyterian Health Plan (PHP) in an External Review ordered by the Public Regulation Commission (PRC). The health insurance company had refused to compensate the youngster and her family for the expense incurred by hyperbaric oxygen therapy (HBOT)-the only therapy that successfully relieved her intractable pain syndrome.

Earlier this year Miss Sanchez was diagnosed with Reflex Sympathetic Dystrophy (RSD), also known as Chronic Regional Pain Syndrome (CRPS). Although Miss Sanchez had been seen by two pain specialists and her condition was confirmed by a neurologist, the health care provider PHP refused to reimburse the Sanchez family.

Miss Sanchez, a 7th grade student at St. Michaels High School in Santa Fe, NM experienced a typical childhood mishap-she slipped on the floor-which led to pain that was disproportionate to the injuries incurred. It was this incident that brought on excruciating pain resulting in the diagnosis of RSD/CRPS, a relatively rare syndrome where the brain gets overwhelmed by pain that can migrate all over the body. RSD/CRPS can cause limbs to swell and muscles to waste. There is no recognized therapy that works to manage RSD/CRPS but doctors try to control RSD/CRPS in adults with large does of narcotics or by cutting sensitive nerves.

There is no conventional treatment approved for children suffering from RSD/CRPS. Susan Luna-Sanchez, Miss Sanchez’s mother, scoured the Internet searching for alternatives that could provide her daughter with relief from her constant suffering. Ironically, her search led her directly to Miss Sanchez’s primary care pediatrician, Dr. Ken Stoller. In addition to being the only Defeat Autism Now! trained pediatrician in New Mexico, Dr. Stoller is also the Medical Director of the Hyperbaric Oxygen Therapy Clinic of New Mexico ( Hyperbaric Oxygen Therapy Clinic of New Mexico ).

Kirtland Air-force base (377th Aerospace Medical squadron) exclusively uses the hyperbaric chamber at Dr. Stoller’s center for pilots that have been diagnosed with decompression sickness.

Miss Sanchez was successfully treated at the Hyperbaric Medical Center of NM, and her CRPS symptoms have been kept in check with HBOT therapy.

Luna-Sanchez stated that Presbyterian was willing to pay for any therapy but HBOT even though the HBOT therapy was successfully keeping Angel’s RSD/CRPS symptoms in check, allowing her to return to having a normal life. "As a parent, I would encourage other parents going through similar situations not to give up when running into problems with insurance company criteria. We can advocate on behalf of our children. The more parents who do this, the better chance there is of changing research and treatment practices for all children."

RSD/CRPS patients have come from all over the USA to be treated with hyperbaric oxygen at he Hyperbaric Medical Center of New Mexico in Santa Fe. Most patients experience dramatic improvements in their pain levels.

About Dr. Stoller

Dr. Stoller is President of the International Hyperbaric Medical Association, a Fellow of the American Academy of Pediatrics, a Diplomat of the American Board of Pediatrics, a Diplomat of the American Board of Hyperbaric Medicine, and a member of the New Mexico Medical Society. He was University of California President's Undergraduate Fellow in the UCLA Medical Center's Department of Anesthesiology, and has almost two decades of clinical experience in pediatric medicine.

SO, MAYBE THERE IS HOPE THAT SOMEDAY THIS WILL BE AN "APPROVED" TREATMENT FOR RSD. IT IS SO FOOLISH ON THE PART OF BOTH WORKMEN'S COMP AND INSURANCE COMPANIES TO WITHHOLD PAYMENT FOR HYPERBARICS BECAUSE IT WOULD LIKELY OFTEN PROVE TO BE THE MOST COST-EFFECTIVE TREATMENT. I DO KNOW THAT IN THE PAST YEAR (SINCE WE HAVE HAD OUR HOME CHAMBER) OUR OUT-OF-POCKET MEDICAL EXPENSES HAVE BEEN DOWN DRASTICALLY ... BAISCALLY OFFSETTING THE COST OF OUR CHAMBER.

AND YES, YOU ARE RIGHT ABOUT IT BEING TERRIBLY SAD FOR ONE AS YOUNG AS SARAH TO HAVE TO DEAL WITH RSD ... BUT WE ALL KNOW THAT IT IS A TRAGEDY AT ANY AGE. I HAVE BEEN ASKED, "DON'T YOU JUST WISH IT COULD BE YOU, INSTEAD OF SARAH?", (AND OF COURSE I DO) BUT IN TRUTH I KNOW THAT I COULD NOT HAVE HANDLED IT AS BRAVELY AS SHE AND MANY OF YOU HAVE. IT TRULY BREAKS MY HEART THAT ANYONE MUST LIVE WITH THIS ILLNESS.

JEANNE