Folks, I think we need to give more thought to the "construct" or outline of this before we ask for things like price of medications (which we know are pricey!).
The main reasons why insurance companies are avoiding reimbursements are something like this:
1. Their policies dictate that "experimental" technologies are unproven; this is partly defined by the "legality" or approval of devices by the FDA. The other part of the experimental definition in their policies is driven by long-term efficacy data, which they report is:
- inconclusive,
- resultant from what they perceive as "flawed" or imperfect trial designs (from Europe),
- actually decidedly poor, in that early designs of devices (techniques and designs were truly experimental and certainly prone to high risks) resulted in complications and failures.
2. They are insurance companies, who strive to retain their market power and ability to make profits. Accordingly, their incentive for changing policies are not aligned to ours, by any means! Their policy changes need to go through layers and layers of bureacracy!
The rational for effectively arguing for long term efficacy and cost savings makes sense to folks here, but the approach (construct or outline) of this proposed document is everything. I know this comment is remarkably unconstructive, but perhaps our member friends in the legal world can give us some guidance. Bill, Leanne, others who have have first-hand experience?!
