you have to understand that insurance companied work, according to the diagnostic criteria and guidelines given to them by the pysicians taking care of this illness. They will not go against the state of the art in that field, but can take advantage of "gray" areas.

I am sure that no insurance company will deny treatment of acute myocardial infraction, because the EKG was normal. And no insurance company will deny treatment for leukemia because the blood count was normal.

If the diagnosis of myocardial infraction was defined by cardiologists according to the EKG, or if the diagnosis of leukmia was defined by hematologists as an abnormal blood count, then the insurance companies would have not accepted those diagnoses without "firm" evidence.

If the diagnosis of myasthenia is defined by neurologists, as an abnormal SFEMG, and we read in every text book or review, that a SFEMG done in a weak muscle rules out MG, then why are you blaming the insurance companies for requesting this?

I have recently come across a relatively "open minded" booklet on MG, where it said that the diagnosis of MG is based on 2/3 of the following-

1. response to acetyl-choline esterase inhibitors.
2. diagnostic EMG studies.
3. antibodies to acetyl-choline R or MuSK. but, a strong arguement could be made that a rapid positive response to PLEX or IVIG is enough support for the diagnosis. (only under extreme situations should those be used for diagnostic purposes).

I believe that the person that gave me this booklet got it from the MGFA, so it is accepted as a serious and reliable source.

interestingly in the "further reading" section of this book there is a recomendation for a paper by Michael Ben-Atar, who is the only neurologist that looked at the diagnostic tests (including SFEMG) and assesed their real diagnostic value. (which is not anywhere near what it is claimed to be).

This is a huge step forward (even though it still does not cover all the patients).

Let's hope that in the near future, it will become more widely accepted.

alice