In a recent article in The Connecticut Law Tribune on September 21, 2015, writer Michelle Tuccitto Sullo posted a blog titled “Connecticut Insurer Sued for Not Covering 'Magnetic' Depression Treatment”.
In the article Michelle Tuccitto Sullo brings to light the recent case of a Tennessee man suffering from depression, “who has filed a federal lawsuit against the Aetna insurance company, alleging that the Hartford-based insurer refuses to cover a magnetic therapy treatment for his condition."
"The claim, filed in the U.S. District Court for the District of Connecticut, seeks class action status. Attorneys from LeClairRyan and a California law firm called Psych-Appeal, which focuses on mental-health coverage cases, are among those representing the plaintiff. The claim names as defendants Aetna Inc., Aetna Life Insurance Co., both of Hartford, and MCMC LLC of Massachusetts.”
As a sidebar, Psych-Appeal was featured on the December 15, 2014 CBS News’ 60-Minutes segment about Cigna Insurance:
“The investigative news program “60 Minutes” has examined the alarming frequency with which health insurance companies refuse mental health treatment claims – and the story features one of Psych-Appeal’s clients. The segment aired the evening before the U.S. Court of Appeals for the Second Circuit will consider whether employees with mental illness can directly sue health insurers who deny their claims rather than the employers who sponsor their benefits." - Read more at: http://www.psych-appeal.com/class-action-filed-against-cigna-for-denying-depression-treatment/.
Psych-Appeal also points out that, “In California alone, at least 75 external appeals to other independent review organizations have recognized TMS as a valid, evidence-based treatment for depression since 2011,” said Meiram Bendat, mental health attorney and founder of Psych-Appeal. “We expect this case to highlight the conflicts of interest that independent review organizations have when they are allowed to contract directly with insurers to evaluate claim denials.” - See more at: http://www.psych-appeal.com/class-action-filed-against-cigna-for-denying-depression-treatment/#sthash.vTtZfLt0.dpuf
Insurance companies should note, NeuroStar TMS Therapy® is proven effective, and has been cleared by the FDA since 2008, for the treatment of Major Depressive Disorder (MDD). This, after clinical trials involving 10,000 patients, with less than a 2% discontinuance rate, where 1 of 2 patients experienced partial remission, and 1 in 3 experienced full remission.
According to Tuccitto Sullo, “Walt Cherniak, an Aetna spokesman, indicated on Sept. 21 the company was reviewing the lawsuit, and he declined to comment further.”
The author goes on to state that, “Aetna denied Christopher Meidl's request for coverage of therapeutic repetitive NeuroStar Transcranial magnetic stimulation, or TMS therapy, on the ground that it fell under an exclusion in Meidl's health care plan that doesn't cover services deemed to be experimental, investigational or unproven, according to the lawsuit. TMS uses an electromagnet to generate repeated pulsed magnetic fields that stimulate nerve cells in the region of the brain associated with mood control, according to the lawsuit.”
Far from being experimental or unproven, according to the NeuroStar TMS Thearpy® website, "TMS was included in the 2010 American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Major Depression—guidelines that provide recommendations for how psychiatrists treat depression." In addition, "with over 650 NeuroStar physicians providing therapy, and more than 25,000 patients treated, this novel treatment approach to achieving remission is bringing new hope to patients every day." While the word novel treatment is used, it is apparent that to the patients in remission from their depression, that they would argue strongly against it being unproven.
TMS is only investigational for diseases other than depression. TMS is being used all over the world for symptoms such as PTSD, Tinnitus, Postpartum, and Anxiety. Neuronetics continues supporting such clinical trial programs. Furthermore, currently the Neuronetics study on Postpartum Depression focusses on the response to TMS therapy noting "Participants in this study are medication free."
Meidl’s local attorney, Daniel Elliott of LeClairRyan filed the case in Connecticut, home to Aetna's headquarters. In the article mentioned in this blog, Elliott is noted as deferring comment to attorney Brian Hufford of Zuckerman Spaeder in New York City. Spaeder is said to be seeking a national class action status.
Christopher Blackburn is a partner in Grand Junction, Colorado-based TMS Solutions, which currently provides NeuroStar TMS Therapy treatment to their patients in Colorado and Idaho. Mr. Blackburn believes “it’s unfortunate that [filing a lawsuit] is what behavioral health patients have to do to be heard & be treated, but it’s a step in the right direction for the approximately 16 million adults who suffer from depression...especially if a class action lawsuit were to pass through the courts.” Currently, while there are many insurance companies in Colorado who cover TMS Therapy, Blackburn stated that “unless an insurance company has a written TMS policy it is, indeed, a battle with insurance companies to get single-case agreement coverage for our patients in both Colorado and Idaho.”
When he read the Connecticut Law Tribune article Blackburn shared that he was elated for his patients that additional insurance companies “may finally have to embrace the FDA facts and efficacy of NeuroStar TMS therapy.” Meidl’s attorney, Hufford boldly explained, "TMS is a very effective treatment for depression, and it was a lifesaver for our client." This echoes Blackburn’s experience and that of his TMS Solutions business partner and co-founder Dr. Robert Sammons M.D., Ph.D., of Grand Junction, CO.
In the same article attorney Hufford added, “the case will be a key one for all of Aetna's customers who suffer from depression and want to undergo this treatment. We view this case as very important."
Tuccitto Sullo noted that “The lawsuit seeks an award ordering Aetna to make payment, with interest, of unpaid benefits to the plaintiff and similarly situated individuals who have been denied TMS coverage by Aetna.”
The lawsuit in question seeks to reverse denials of coverage for TMS therapy, as well as open the door to a class action lawsuit. Regardless of the outcome, TMS Solution’s Blackburn hopes the awareness and success of TMS therapy will make his patient’s and the lives of other depression sufferers a little easier.
To learn more about TMS Therapy click the button.
To speak with Chris about insurance coverage, or to find a TMS Center near you, contact TMS Solutions Patient Advocate Chris Blackburn with the link below.