TEXARKANA, Texas (Legal Newsline) - Last month, more than two dozen patients filed a federal antitrust lawsuit against the Infectious Diseases Society of America, major health insurers and a group of medical doctors, alleging the insurers are denying coverage due to “bogus” guidelines established by their paid consultants.

The lawsuit, filed in the U.S. District Court for the Eastern District of Texas, Texarkana Division, alleges the consultants falsely say Lyme disease can always be cured with a month of antibiotics.

Among the named defendant insurers are Blue Cross and Blue Shield, Anthem, Aetna, Cigna and United Healthcare.

“Initially, the Insurance Defendants provided coverage for Lyme disease patients, covered long-term antibiotic treatment, and even paid for extended hospital stays to treat patients with Lyme disease who did not respond to short-term antibiotic treatment,” the 53-page complaint states. “This allowed doctors to properly assess and treat patients with chronic Lyme disease and prevented the suffering and death of many thousands of Lyme disease patients.”

Then, in the 1990s, the insurers decided that treatment of the disease -- which is transmitted through the bite of infected ticks -- was too expensive and “red-flagged” it, according to the lawsuit.

“The health insurance industry made a concerted effort to deny coverage for treatment of Lyme disease. The Insurance Defendants enlisted the help of doctors who were researching, not treating, Lyme disease,” the 28 plaintiff patients allege.

“The Insurance Defendants paid these IDSA Panelists large fees and together they developed arbitrary guidelines for testing Lyme disease. Once these arbitrary guidelines were decided, the Insurance Defendants could, and did, deny coverage for patients if they did not meet their new stringent Lyme testing protocols.”

According to the lawsuit, the insurers, with the help of the paid IDSA panelists, decided long-term antibiotic treatment wasn’t necessary and all Lyme disease patients could be cured in less than a month. 

Large sums of money were paid by the insurers to various doctors in consulting fees, expert witness fees, and to review and deny insurance coverage claims related to Lyme disease, the complaint alleges.

“These payments, as well as communications related to the doctors’ responsibilities and findings, were sent from the Insurance Defendants to these IDSA Panelists,” the lawsuit states. “These payments and communications harmed Plaintiffs because they deprived Plaintiffs, and all other people suffering with Lyme disease, insurance coverage and prevented them from being properly diagnosed and treated for Lyme disease.

“Additionally, Plaintiffs, and all others suffering with Lyme disease, were forced to pay out-of-pocket for their treatment, thus costing them vast sums of money.”

According to the lawsuit, IDSA published the first guidelines for treating Lyme disease in 2000, similar to those imposed by the defendant insurers.

Then, in 2006, the IDSA guidelines were updated. The plaintiffs contend they became “even more restrictive.”

But IDSA, following a settlement with the Connecticut Attorney General’s Office in 2008, agreed to conduct a new review of its guidelines.

The attorney general at the time, Richard Blumenthal, had filed an antitrust lawsuit against IDSA to determine whether conflicts of interests may have affected the development of IDSA’s Lyme disease guidelines.

It was the first time antitrust allegations were levied against the developmental process of a medical society’s guidelines.

However, in 2010, IDSA said its review panel found no need to change or update its 2006 Lyme disease guidelines.

“While we cannot comment on pending legal matters, we want to assure you that the priority of the Infectious Diseases Society of America (IDSA) is to promote human health through excellence in infectious diseases research, education, prevention, and patient care,” an IDSA spokeswoman told Legal Newsline.

“In developing guidelines for the treatment of infectious diseases, including Lyme disease, IDSA authors rely on evidence-based research performed according to widely accepted scientific standards and consider, when appropriate, anecdotal evidence.  The published guideline, ‘The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis,’ reflects the best information science provides for the broad range of physicians who might treat a patient with symptoms of Lyme disease.”

But the plaintiffs contend it all comes down to money.

“The reason hundreds of thousands of people suffer with chronic Lyme disease is because they are refused long-term antibiotic treatment beyond the 28 days. The Insurance Defendants ignore their patients, ignore the results (people who get better with long term antibiotic treatment), ignore the many studies showing that many patients need antibiotic treatment beyond the 28 days, and ignore the doctors who keep saying that some patients need long term antibiotic treatment,” their lawsuit states.

“The Insurance Defendants refuse to provide insurance coverage for long term antibiotics, which could cure the chronic Lyme disease simply because the Insurance Defendants do not want to pay for the treatment.”

The plaintiffs contend the defendant insurers work with and compensate the IDSA panelists to keep the 28-day standard in place. In turn, the panelists benefit financially from their arrangements with the insurers.

Houston law firm Shrader & Associates LLP -- known mostly for its mesothelioma work -- is serving as lead counsel for the plaintiffs. Rusty Hardin & Associates LLP and Hanszen LaPorte in Houston are representing the plaintiffs.

From Legal Newsline: Reach Jessica Karmasek by email at jessica@legalnewsline.com.

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