Case Study
Each quarter, this section will highlight an AfPA member whose advocacy work has successfully improved patient access to approved therapies. Do you have a case study you'd like to share? If so, please contact AfPA at .
Barbara Schultz, MD:
Passion and Persistence Corrects an Injustice in Dallas
The Problem
AfPA member Barbara Schultz, MD, an otolaryngologist from Dallas, Texas, has a patient with spasmodic dysphonia who had been receiving botulinum toxin type A (BOTOX®) injections for the past ten years when her provider – Blue Cross Blue Shield (BCBS) – said it would no longer cover it because its new policy considered the treatment cosmetic. The policy change had occurred without any notification to patients or providers.
Action Taken
Dr. Schultz sent appeal letters and made phone calls to the regional BCBS medical director to alert him to the error and request a change in the policy. She also supplied supportive data on the use of BOTOX for SD. At the same time, other SD patients in Dr. Schultz’s practice were receiving reimbursement for BOTOX from the same provider.
The Result
After Dr. Schultz pleaded her case to the national BCBS authority in Illinois, the provider finally agreed to change its policy to provide patient access to BOTOX for all SD patients; however, it denied making a mistake and refused to pay the patient’s back bills for BOTOX. After more protest from Dr. Schultz, BCBS reconsidered and agreed to reimburse the patient.
What Worked
Stick-to-itiveness and a passion to correct an injustice contributed to Dr. Schultz’s success. Her case is also a great example of how lobbying for a change in policy takes the same amount of time and energy as appealing for an individual patient, but impacts all patients covered by the policy. By working together to change policies, physicians from the same region will avoid fighting the same battles again and again. AfPA can provide resources and support to ease the burden of physicians advocating for policy changes.
Comments From Recent Website Visitors
I have Spasmodic Torticollis which is also treated with BoTox. I had similar difficulty with Blue Cross when trying to get surgery approved. I want to thank Dr Schultz for her efforts to fight the insurance companies on our behalf. Please pass on my thanks to her.
Janice Johnson, Arlington, TX