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Click here to download a 43 page document that was used at our HMO's External
Appeal (see overview below):
Overview
This medical thesis paper is being provided for External Appeal for continued
healthcare services for Anne for allergy testing, treatment and services from an AAEM
Physician (American Academy of Environmental Medicine). Univera Healthcare does
not have a Board Certified Environmental Medicine Physician in the Univera network.
If Univera Healthcare did have a Board Certified Environmental Physician in the
network there would be no reason for this appeal.
For the purposes of this paper the following terms all refer to the same services:
intradermal neutralization testing, intracutaneous provocative food testing (IPFT),
provocation-neutralization treatment, provocation-neutralization testing (P/N),
provocative food test,as well as symptom-provoking and relieving food test. This paper
is authored by Lisa A. Lundy, Anne’s biological mother, and as such the reference to
“I” in this paper refers to me. The references to “we” , “our”, and “us” in this paper refer
to my Husband of nine years, Randy, and myself. We have intentionally excluded
the names of several physicians from this paper as some information in this paper may
not reflect those physicians in the best light and we are not out to malign anyone’s
character or reputation. This paper shall address the following issues:
1. Historical background of food allergy
2. Medical background of the family and of Anne
3. Effectiveness of said allergy services for Anne
4. Dispelling the Myth that there is any real controversy in this field of science
5. The Issue of Medical Necessity
6. Rationale for why these allergy services are not experimental or investigational
7. Rationale for discriminatory reimbursement policies and practices
8. Summary
Appeal (see overview below):
Overview
This medical thesis paper is being provided for External Appeal for continued
healthcare services for Anne for allergy testing, treatment and services from an AAEM
Physician (American Academy of Environmental Medicine). Univera Healthcare does
not have a Board Certified Environmental Medicine Physician in the Univera network.
If Univera Healthcare did have a Board Certified Environmental Physician in the
network there would be no reason for this appeal.
For the purposes of this paper the following terms all refer to the same services:
intradermal neutralization testing, intracutaneous provocative food testing (IPFT),
provocation-neutralization treatment, provocation-neutralization testing (P/N),
provocative food test,as well as symptom-provoking and relieving food test. This paper
is authored by Lisa A. Lundy, Anne’s biological mother, and as such the reference to
“I” in this paper refers to me. The references to “we” , “our”, and “us” in this paper refer
to my Husband of nine years, Randy, and myself. We have intentionally excluded
the names of several physicians from this paper as some information in this paper may
not reflect those physicians in the best light and we are not out to malign anyone’s
character or reputation. This paper shall address the following issues:
1. Historical background of food allergy
2. Medical background of the family and of Anne
3. Effectiveness of said allergy services for Anne
4. Dispelling the Myth that there is any real controversy in this field of science
5. The Issue of Medical Necessity
6. Rationale for why these allergy services are not experimental or investigational
7. Rationale for discriminatory reimbursement policies and practices
8. Summary
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