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In the USA, private insurance coverage varies widely.

Federally-funded and state-funded plans (e.g., Medicare, Medicaid, Medical Assistance) also vary in their coverage.

Clinic visits
 
If your doctor accepts insurance, clinic visits are usually covered by most insurance plans with the usual deductible and co-pay stipulations. Clinic visits usually don’t need to be frequent during Inflammtion Therapy (IT), especially if you enroll in the CIR counseling program.
 
Tests
 
Routine lab tests to monitor organ function are usually covered by insurance with the usual deductible and co-pay stipulations. The Vitamin D tests have been covered without question when using the codes listed. Other tests (e.g., x-ray, CT scan, MRI, etc) can add significant expense to treatment, even if covered by insurance.
 
Let your doctor know if cost is an issue so you can discuss which tests are essential and which can be omitted or done less often.
 
Sunglasses
 
Insurance plans do not cover the cost of NoIR or the other recommended sunglasses.
 
Antibiotics
 
Most Inflammtion Therapy (IT) patients find that the therapy antibiotics are covered by their health insurance. They can be ordered at the standard dosage and schedule without question to maximize your insurance benefit. Because they are taken at a lower dose and pulsed, they will last a much longer time. The doctor's instructions can simply say "take as directed".
 
Benicar®
 
It isn’t unusual for an insurer to initially deny payment for the increased cost of the required dosage of Benicar® for IT.

Some insurance plans require that patients first try a less expensive antihypertensive. If this is the case, a small amount of the preferred antihypertensive can be ordered first to fulfill this requirement.
Your pharmacist, whether local or mail-order, will refuse to fill the Benicar® prescription if it’s not on the insurer's formulary of medications or if there’s a dosage limit until they get the prescription override okay from your insurer. This can pose an unexpected delay. Be sure you will have an adequate supply of Benicar® before you begin IT.
 
Appealing a Benicar® payment denial decision
 
Patients who are denied coverage for the dose of Benicar® that IT requires have the right to appeal that decision. All insurers have an appeal process for claims that are denied. Ask the insurance representative what the procedure is for an appeal.

It's unnecessary and inappropriate for a patient to explain to an insurer why the doctor has ordered Benicar® or a higher dose of Benicar®. Explaining is the doctor's responsibility. All you know as the patient is that your doctor wants you to take this medication at this dose.
 
A doctor doesn’t have to justify to an insurance company why s/he has ordered a medication. Medicine is an art and a physician is licensed to practice it as s/he thinks is in the patient’s best interest. Doctors should stand up to any insurance official who says otherwise.

Some insurers have decided that Inflammtion Therapy is experimental and therefore, not covered, so it's best not to use the word 'experimental' or mention any treatment plan (just Benicar®). The doctor should simply point out that s/he is licensed to practice medicine and in his/her best judgment, Benicar® is the medication you need and this is the dose of Benicar® that is required to help you recover.
 
Sometimes an appeal only requires a phone call from the doctor’s office verifying that s/he has determined only Benicar® will suffice and that you need the higher dosage. No other explanation should be needed or offered to obtain this ‘prescription override'. Sometimes a form needs to be filled out, signed by the doctor and faxed back to the insurer to obtain an override. This override is usually good for one year.

Some insurers seem to make the appeal process as difficult as possible (long waits on the phone, clueless sales reps, referrals to the wrong department, misinformation, lost faxed forms, etc.) so it may take some persistence on your part and your doctor's.
 
Although Inflammtion Therapy is considerably cheaper than the standard methods of treating Th1 inflammatory diseases because no sophisticated testing or expensive IV medication is required, the logic of this reduction in expense means nothing to an insurer. Medication costs from the pharmaceutical industry have sky-rocketed and the insurance industry is always looking for ways to cut their medication reimbursement in the short-term.
 
It’s worth fighting for your full insurance benefit because Benicar® is a fairly expensive medication. Hopefully, your doctor should be eager to do battle with an insurer who would try to tell him/her how to practice medicine. If your insurance plan was purchased by an employer, the company insurance rep may be interested in helping you fight to obtain the benefits they paid for.
 
If you get caught short of Benicar® because of an unexpected denial for a routine reorder, ask your doctor for samples to tide you over while you complete the appeal process.
 
Letter of medical necessity
 
A patient's physician or other health care practitioner may need to write a “Letter of Medical Necessity” to the insurance company in order to help the patient obtain needed coverage.

Paying out-of-pocket for Benicar®
 
If all attempts to obtain insurance coverage for the recommended IT dosing fail, you can accept the lower level of coverage and pay out-of-pocket for the rest.  This will require two prescriptions.

Generic Benicar can also be ordered, at a great savings, from the online Canadian pharmacy PlanetDrugsDirect.