Today an envelope came from UPS, Glenlake Parkway, Atlanta, Ga.. it was with great anticipation that I opened it and read the two page letter..........
several paragraphs of blah blah blah about medical standards and than this;
"Upon receipt of your appeal, the Committee requested that a peer physician review all submitted documentation. The specialty reviewer is board certified in orthopedic surgery. Based on the peer physician's review of the information submitted, the proposed ACI of the ankle is considered experimental and/or investigational at this time. This procedure uses Carticel implantation cells provided by the Genzyme Corporation. Their official literature notes that Carticel implantation is to be used to repair symptomatic cartilage defects in the knee only. The rationale for its use in other joints is the lack of any long term, multi-center, randomized controls or long term multi-center, many patient observations, nor is it recommended by the FDA at this time for your condition.
After a thorough review of the information submitted and the opinion of the peer physician, the Committee finds that the proposed ACI ankle implantation is experimental and/or investigational and is not "medically necessary and appropriate" in accordance with the terms of the Plan, as interpreted by the Committee. Therefore, based on the records and the terms of the Plan, the Committee has denied your appeal."
The last paragraph was a regret for the unfavorable review, and that I do have the option to bring a civil action in federal court.....
So there you have it.. The lesion will remain in place, I will not be relieved of the pain level in activity and normal usage.. But I will just have to take that risk with returning to an active life and if necessary use pain meds.
Thank you for the years of prayer in this situation. I appreciate you. Now let's move on.......
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