If your insurer is using the

IDSA Lyme Disease Guidelines

To deny you benefits...

The response below should be

Submitted with your documents.


Conflicts of Interest and Bias

After a lengthy investigation, Attorney General Richard Blumenthal (currently US Senator), stated the medical guidelines used as a basis for the opinions in your denials have “sweeping and significant impacts on Lyme disease medical care.” He further stated the guidelines “are commonly applied by insurance companies in restricting coverage for long-term antibiotic treatment or other medical care and also strongly influence physician treatment decisions.”

Blumenthal added, "The IDSA's 2006 Lyme disease guideline panel undercut its credibility by allowing individuals with financial interests -- in drug companies, Lyme disease diagnostic tests, patents and consulting arrangements with insurance companies-- to exclude divergent medical evidence and opinion. In today's healthcare system, clinical practice guidelines have tremendous influence on the marketing of medical services and products, insurance reimbursements and treatment decisions. As a result, medical societies that publish such guidelines have a legal and moral duty to use exacting safeguards and scientific standards.”

He found the “IDSA included in its Lyme guidelines a statement calling them "voluntary" with "the ultimate determination of their application to be made by the physician in light of each patient's individual circumstances." However, he followed up by stating, “United Healthcare, Health Net, Blue Cross of California, Kaiser Foundation Health Plan and other insurers have used the guidelines as justification to deny reimbursement for long-term antibiotic treatment.”

Not only is the foundation of your report flawed by using the infectious disease organization’s guidelines, the neurology guidelines are equally tainted. AG Blumenthal determined:

“The IDSA portrayed another medical association's Lyme disease guidelines [American Academy of Neurology–AAN] as corroborating its own when it knew that the two panels shared several authors, including the chairmen of both groups, and were working on guidelines at the same time.”

He further stated, "My office uncovered undisclosed financial interests held by several of the most powerful IDSA [and AAN] panelists. The IDSA's guideline panel improperlyignored or minimized consideration of alternative medical opinion and evidence regarding chronic Lyme disease, potentially raising serious questions about whether the recommendations reflected all relevant science.”

It is obvious by your denial that these same tactics were utilized by your reviewers, as there was no science to support the opinions expressed, and the comments made were the basic cookie-cutter lines used by the IDSA/AAN and their members as a self-serving approach to the diagnosis and treatment of Lyme disease.

Blumenthal stated, “The two entities [Infectious Diseases Society of American and American Academy of Neurology] sought to portray each other's guidelines as separate and independent when the facts call into question that contention. The IDSA subsequently cited AAN's supposed independent corroboration of its findings as part of its attempts to defeat federal legislation to create a Lyme disease advisory committee and state legislation supporting antibiotic therapy for chronic Lyme disease.”

Organizations and its members that go to the extent these two have to thwart federal (and state) legislative efforts designed to improve the health and lives of citizens across the country can not be trusted to be impartial or honest in their day-by-day activities. Therefore, utilizing either or both the AAN and IDSA flimsy, seriously flawed and unsubstantiated guidelines to justify and uphold the denial of my benefits is a serious breech of our contract.

Additionally, opinions expressed by Infectious Diseases Society of America and the American Academy of Neurology members defied official recommendations set forth by federal (NIH, CDC, FDA), state (NY Health Department) and other organizations and medical institutions in regards to Lyme disease diagnosis and treatment. See attached scientific documentation.

The opinions stated in your denial are totally without merit. Your clinical experience with successfully treating chronic Lyme and tick borne disease patients is non-existent.

Therefore, without a doubt or second thought, your denial should be totally dismissed, in part for the bias and conflicts of interest, unsubstantiated and unprofessional opinions, the omissions of facts, inaccurate and misleading statements, and lack of science to support their claims. In light of this situation, all of my benefits should be reinstated, retroactively, immediately.