Statement to the California Department of Managed Health Care (DMHC):

I am seeking Vagus Nerve Stimulation (VNS) for the treatment of long-term, treatment-resistant depression. Blue Cross of California, my healthcare provider through California's Major Risk Medical Insurance Program, has denied coverage for this treatment; the initial denial was on the basis of it being "experimental" (even though VNS was FDA-approved in 2005 for the treatment of depression), and then my appeal was rejected on the basis of VNS "not being medically necessary". I have filed a grievance with Blue Cross of California and am now requesting that the Department of Managed Health Care (DMHC) conduct an Independent Medical Review (IMR) of my case.

I have been struggling with depression since I was 13 years old; I am now 35. Over the past 22 years, I have tried 10 different medications, seen more than eight different doctors for either medication management, talk-therapy, or both, and worked with at least three different counselors (including a hypnotherapist). I have been hospitalized twice: the first was an eight-week hospitalization for suicidal ideation and severe depression when I was 13-14 years old (my 14th birthday took place while I was hospitalized), and the second was an overnight emergency stay for suicidal ideation in March, 2005 (I was 33).

Right now, I take anti-depressant medication (Celexa), an anti-convulsant (Trileptal) for mood regulation and idiopathic partial seizures (from temporal lobe dysfunction seen on brain scans, though EEG-Telemetry results were negative), and stimulant medication (Dexedrine) for AD/HD. But I am currently in a depressed state, and have been for quite some time.

I am once again experiencing crying spells, deep despair, tiredness and fatigue. Completing domestic chores is exhausting and a struggle. I am not working full time and getting financial assistance from my father, but it is not enough to pay the bills; I am unable to adequately take care of myself. Normally outgoing and extroverted, I have refrained from most social activity for the better part of this year.

I am tired of struggling with this disorder. I am 35 years old and want a chance at life. I want to work, take care of myself, get married, have children, and participate in the world. VNS has been FDA approved for depression for over two years, has been shown to be effective. I have struggled with depression for over 22 years in which I have tried 10 different drugs plus talk therapy, been hospitalized twice for suicidal ideation, and seen more than eight different doctors plus additional counselors. Vagus Nerve Stimulation (VNS) is a logical next-step in the course of my treatment.

My health insurance coverage is through California's Major Risk Medical Insurance Program (MRMIP). I am in San Mateo County, and my choices for coverage are limited to two providers: Kaiser and Blue Cross (of California). I have Blue Cross of California's PPO, for which I pay $432.50 per month (for just me) for $75,000 of coverage per year. Kaiser Permanente's HMO is not a feasible choice for my health coverage, because, as has been my experience in the past, I would need to be referred to and fully (re)-evaluated by one of their own specialists just to receive coverage for medications I have been taking for years. So Blue Cross is, practically speaking, the only choice of provider I have. Blue Cross is denying coverage for an FDA-approved treatment for depression (that I meet the candidacy requirements for), yet switching healthcare providers is not an option for me (if it were an option, I wouldn't need coverage through MRMIP).

Simply put, Blue Cross of California is using State funds to provide only inadequate treatment for my condition while denying coverage for an FDA-approved course of treatment that is appropriate for me at this point in time; no doubt this is done with the full knowledge that I am stuck with them as my healthcare provider, seeing as I am covered through MRMIP and am treated by specialists who are not with Kaiser's HMO. I believe this is not right.

I am requesting that the California DMHC conduct an Independent Medical Review of my case, as I have exhausted the appeals and complaint process with Blue Cross of California. I am hoping that the IMR will conclude that Vagus Nerve Stimulation (VNS) is an appropriate course of treatment for my condition at this time, and direct Blue Cross of California, as my healthcare provider through the California's Major Risk Medical Insurance Program, to provide coverage for VNS treatment as prescribed by my doctor. I acknowledge and understand that my coverage is limited to $75,000.00 per calendar year.

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1. Carry the card in your wallet with your insurance card.
2. If denied treatment, show your SiCKO card to your doctor/insurer.
3. Ask your insurer if they'd like to be in Michael Moore's next movie, DVD, or appear on MichaelMoore.com.
4. Tell them that, if denied, you will seek coverage from your local media.
5. E-mail your story to michael@michaelmoore.com.

To the Department of Managed Health Care (DMHC) and Blue Cross of California:

I am prepared to go this route if necessary. The recent suicide attempt of actor Owen Wilson has thrust Clinical Depression into the national spotlight, and I am willing to go public with my own story. It is my hope that this matter can be resolved privately; the process thus far has been enough of an affront to our collective dignity!

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The above has been sent to the California Department of Managed Health Care (DMHC) as part of my petition for an Independent Medical Review (IMR). This is the last step in what has been a year-long process trying to get insurance coverage for VNS therapy. The DMHC is my last hope for getting this treatment. I should know by the end of next week if an IMR will take place, and if one does, the decision will be made within 30 days as to whether or not Blue Cross will be forced to provide coverage. The surgery costs about $60,000 if paid out-of-pocket.

Please wish me luck. I'm feeling like shit. I hate the holidays.

What is VNS Therapy? http://www.vnstherapy.com/depression/whatisvnstherapy/

hopes that you get the treatment that you need to allow you to permanently live a healthy, robust, creative, love-filled life.

:hug:

Your response means the world to me...

I love the picture with the Earth and the purple...I actually saved it to my hard drive several months ago! :)

:hug: to you too!

:)