Intersting, In Terms of Insurance

Of all the readings that we have read thus far, the one that has stuck out the most to me was the David Brang report “Apotemnophilia: a neurological disorder.” Brang describes a study that he helped run at the University of California, San Diego that suggested that Apotemnophilia actually has a neurological basis (as opposed to being entirely psychological, as was previously thought).

I remember that when we initially discussed this article in class, the question of insurance arose. It’s an interesting question. Who covers this? I am very close to someone who works for the Department of Human Services in Healthcare Purchasing and Servicing for the state of Minnesota. This deals with insurance in terms of peoples’ coverage and eligibility for programs such as Medicare (a federal program for seniors and people with disabilities) and Medicaid (a state and federal program that coverers various healthcare issues that are predetermined by each state). I was speaking with her about the issue of Apotemnophilia’s coverage by insurance shortly after our discussion in class and she had some very interesting things to say about coverage.

While there is a definite condition that has been identified, the person with whom I was conversing with says that there are definitely some issues that come up when faced with the issue of coverage. While most insurance plans differ, for the most part they do cover various neurological disorders and the accepted, appropriate treatments. There seems to be issue with the fact that there isn’t something visibly wrong with the limbs in question. If a doctor cannot actually see anything wrong with the limb that an Apotemnophiliac wishes to remove, there is no reason for a state or federal program to cover that. Policy makers will most likely side with people who need treatment for some other, more acceptable condition. The problem with insurance is that there is so much grey area when it comes time to speak about coverage. For example, Medicare and Medicaid in Minnesota will cover standard treatment for Epilepsy (medications, surgeries, medical consultations that patients were referred to, etc.), but these programs will not cover treatments such as Vagus Nerve Stimulation, as their policy reflects the viewpoint that this is an experimental treatment. While Apotemnophilia is in no way the same as Epilepsy, this person is certain that the treatment would be viewed the same (because the lines defining this condition are so fuzzy). BUT, here’s the interesting part: Medicare and Medicaid WOULD (most likely, under most circumstances) cover the costs of the surgeries that it would take to reattach (or remove) an Apotemnophiliac’s limb/appendage after they had tried to remove it themselves. In the Elliot article, he mentions the person that tried to give themselves gangrene so they could have their limb removed: this would most likely be covered by insurance (especially if you were on Medicare or Medicaid – unless you outright told your insurance company that you purposely mutilated yourself for your wellbeing…then things could get messy).

All of the above are just answers to questions that I had or thoughts that I had that were responded to by a state employee. I’m really interested in this in terms of insurance. It brings up all the questions of acceptability and who deems things acceptable as well as a glut of other issues…but my post is getting a tad bit long. I just found this all very interesting.