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February
15, 2000
Carroll W. Cederburg, M.D.
Associate Medical Director
Blue Shield of California
Dear
Dr. Cederburg,
This
letter is in reply to your inquiry dated August 10, 1999 regarding the medical
necessity of my treatments for various patients. It will demonstrate that not
only are my treatments necessary, but they have saved thousands of dollars for
Blue Shield.
I
have been a Blue Shield member for years, and have never encountered this en
mass denial. Although the therapies we billed for have not changed during this
time, Blue Shield has progressively reduced our reimbursement. I feel that you
are resolving the cost problem the wrong way, because:
1.
Symptomatic
orthodox therapies are
the culprit for our health dilemma.
2.
Curative
treatments, such as my
mine, improve care and reduce cost.
3.
The patient rather than reviewers should determine the necessity of a
therapy.
4.
A free market is the only solution for our health care dilemma.
Symptomatic
orthodox therapies are the culprit for our health dilemma
I
was trained in orthodox medicine, but have recognized early in my career the
fallacy of conventional treatments. Drugs and surgery treat symptoms,
but never correct the cause to cure the disease. This
“palliative” approach to resolving a problem is unacceptable even in
nonprofessional trades!
For
example, no one would paint over wall stains on a daily basis without fixing the
leak that caused them. This treatment is invalid no matter how many experimental
trials have proved the efficacy of a particular paint in masking these
blemishes.
Similarly,
using drugs to suppress symptoms ad infinitum is fallacious; no matter how much
research has “affirmed” their efficacy. Life-long drug therapy is the main
reason for astronomical health care costs. Moreover, the untreated underlying
disease continues to decay the body, which is further aggravated by the side
effects of drugs and surgery, resulting in a vicious cycle of sicker patients
and more costly therapies.
A
study published in JAMA (4/98) indicates that properly prescribed drugs in hospitals kill over 100,000 people a
year and ranks 4th as a leading cause of death in the US. This data
does not include mortality and morbidity outside of hospitals, from improper
prescriptions, surgery and invasive procedures, or unreported cases, which can
significantly worsen the statistics, as most adverse reactions are not reported.
Another
study shows that adverse reactions from drugs and surgery in hospitals are the 5th
leading cause of death. It accounts for 11% of all ICU admissions annually for
the past 25 years. This dismal figure has not changed despite the progress in
medical technology.
The
Institute of Medicine recently reported that doctors’ mistakes kill up to
98,000 people a year, and rank 8th as a leading cause of death in the
US, while blunders by British orthodox doctors kill over 40,000 a year, and is
their 3rd leading cause of death. Last but not least, the
number one risk of death for Americans 35 or younger, according to CDC
statistics, is under the category of “unintentional injections and adverse
reactions” – a euphemism for the complications of conventional treatments!
It
is amazing that doctors can get away with such an enormous amount of deadly
errors, while a worker in any other field is held accountable for the slightest
damage done during a repair! The grotesque adverse effects and errors exasperate
the already exorbitant cost of the conventional system. Hence, millions are
fleeing from the onslaught of modern therapeutics, and selecting safer and less
expensive natural alternatives, as demonstrated by Einsenberg’s studies in the
NEJM.
The
evidence is obvious. A medical system using palliative therapies that are
inherently harmful is unacceptable. We need a more cost effective alternative,
specifically one that can cure a disease by eradicating its root causes.
A
curative treatment is the key to improve cost and care
I
have discovered the cure for
degenerative ailments by exploring beyond the allopathic Newtonian material paradigm into an energetic
universe, envisioned first by the ancient Chinese and then by Einstein. My
treatment, called Neuro-BioEnergetics (NBE), is a combination of eastern and
western medicine. It cures chronic ailments by enhancing innate healing; using natural materials employed by Nature, and
avoiding synthetic toxins that drain the energy crucial in the repairing
process.
Chinese
medicine has the right concept, but lacks effective modalities to control severe
symptoms. Adding nerve blocks and injections of energy (trigger) points can
dramatically improve results. Homeopathic and food supplements are incorporated
to correct energetic and material
deficiencies caused by the abnormal modern lifestyle.
Explaining
my therapy would require a complete paper. The intent here is to use the cases
being denied to show that this method is superior to orthodox therapies.
Discussed below are my treatment results on these patients. My results may seem
incredible, but are substantiated by ample case histories (ch) and audio patient
interviews (pi) posted on www.drtong.com.
You are encouraged to obtain their phone numbers from our office and
verify the facts with the patients.
Larry
C (letter enclosed, pi/ch) is a former Wimbledon player who has developed osteo-arthritis
from prior injuries and a knee surgery. He had progressively lost the ability to
play tennis in the last two years, despite repeated drainage of synovial fluids,
cortisone shots, and many drugs. Instead, he developed gastric discomfort from
the drugs requiring more drug treatment! Finally, a board certified orthopedist,
based on MRI evidence, recommended knee replacements and that he stop playing
tennis.
In
addition, an accident 30 years ago had caused pain in his neck and right wrist,
which consistently became worse, resulting in headaches, torticollis, and
bilateral supra-orbital twitching. The problems continued to deteriorate despite
all the pharmaceutical miracles.
As
stated in his letter, his knees were much improved from his first
NBE treatment, and when he called my attention to his chronic neck pain in
the third visit, it was also instantly alleviated – first real relief in 30
years!
Further
treatments eliminated most of his pain, enabling him to win second-place in a
tennis tournament against former world-class players. Instrumental to his defeat
was another one of my patients, Daud (letter enclosed, pi/ch), who was initially
worse off than Larry, but has regained full vitality due to my care.
Parker,
Larry’s son, was top in his high school tennis team. Yet pain in his back and
neck as well as problems with stamina impeded his performance. He was also
diagnosed with obsessive-compulsive and attention deficit disorders for which
Ritalin was prescribed. Preferring a non-drug alternative, he overcame his
needle phobia to visit me.
Parker
was also improved by his first NBE treatment. The second enabled him to compete
in a three-hour match and successfully served 15 consecutive first serves -
something that he couldn’t do before. He lost his fear of the needles, and
always came in for a treatment before his tennis matches. Eventually, his
physical and mental problems were all resolved.
Sara,
Larry’s daughter, also had difficulty with attention deficit. Nancy, his wife,
had suffered from neck and shoulder pain, for which surgery was suggested. Both
were fearful of needles, but had similar success with our therapy and instant
relief from their first treatment. None of the family members needed any drugs
after their initial visits.
Dan
F. (letter enclosed) was educated as a pharmacist, but went into management. He
suffered from spinal stenosis, and herniated lumbar disks documented by two
MRI’s and a nerve conduction test. Orthopedic and other specialists treated
him with narcotics, muscle relaxants, and physical therapy, without success.
Surgery was suggested.
Compounding
his physical suffering was excessive emotional stress, depression and anxiety
attacks, which were not relieved by Prozac and Remeron. He had a dreadful fear
of injections, yet he drove 1-2 hours one way, depending on the traffic, to see
us. He could tolerate only one injection for the initial visit, but
nevertheless, experienced enough relief to return for additional therapy.
The
second treatment convinced him about the therapeutic benefits, because his
anxiety, depression, and the back pain were all greatly alleviated. He referred
his friend Cookie (below) to us. Albeit he could not comply with his regular
treatment schedule because of his work and the long distance, the few treatments
he had enabled him to reduce his antidepressants by 50%, and at one point
discontinue all analgesics.
Leigh
S. is physician who similarly does not believe in drugs. The stress from her
busy practice resulted in multiple somatic pain and hormonal imbalance, which
had been exacerbated by prior alternative therapies (alternative therapies can
also be harmful). She came for quite a few treatments because she was able to
obtain relief each time.
Dan
M. (letter, pi/ch) is a college student who would have committed suicide if not
for the NBE therapy. He had severe anxiety attacks and depression, causing
symptoms of pain, nausea, and weakness. Fortunately I was able to help him, also
from the very first visit. At the time he discontinued therapy, he stated he was
no longer suicidal. I feel that he needs further treatments.
Yet he cannot continue due to unreasonably low insurance reimbursement
and non-coverage of supplements that were helpful.
These
represent my typical results. Because the NBE therapy rectifies the cause of a
disease, it can be stopped at some point, with the patients maintained on a
proper diet, and periodic “tune-ups” for prevention. The quality of care
from this approach is optimal.
On
the other hand, allopathic therapy is a vicious cycle of symptom-suppressions.
The decay caused by the untreated root disease and the side effects of drugs and
surgery is amplified by the reductionistic approach. The focus is on organic
parts and laboratory tests, but not the patient. The result is the
aforementioned horrible statistics, unparalleled in the history of humankind.
Furthermore,
the cost of the NBE method is miniscule compared to that of conventional system.
Dan F. told me that thousands of dollars have been wasted on specialists,
MRI’s, and a nerve conduction tests. These tests were a complete waste, since
I proved that surgery was not necessary, and they were not needed in the
selection of drugs.
And
this is just the beginning. All these wasteful diagnostics and harmful
therapeutics will be repeated time and again because the underlying disease is
never cured. The cost of this approach is prohibitive, and we further subject
patients to the dreadful risk of failed back or other surgery syndromes.
With
my approach, expensive tests are not required. I have not needed one MRI in over
16 years of pain management. Furthermore, all ailments including mental
aberrations can be reversed, eliminating the need for life-long therapies by
multiple specialists, each of whom usually requires more expensive diagnostics,
drugs, and surgeries.
Hence,
it makes no sense that you would disallow a treatment that is so cost-effective,
forcing these patients either back on the expensive harmful orthodox system,
which you would pay for, or to seek unorthodox therapies, which you would deny
on the grounds of lack of medical
necessity!
Therefore
we need to scrutinize what the physicians imply by “medical necessity.”
The
patient rather than reviewers should decide on the necessity of a treatment
Simply
put, a sick patient needs medical treatment. Physicians complicate the matter by
claiming that they know more than the patient on what therapy is most
appropriate. In reality, the patient knows the effect of a therapy better than
anyone else. Thus, the necessity of a treatment ultimately should be the
patient’s decision. Having
a third party making this decision causes a conflict of interest. Let me explain
by examples.
Cookie’s
(pi) therapies were denied by a physician reviewer. Please listen to her
interview on my web site under “pilonidal cyst.” For years she had received
treatment from physicians for multiple chronic ailments. She stated that their
drugs not only did not help, but also had caused permanent damage.
She
became unemployed after trying different alternative therapies, including three
years of acupuncture, with only minimal results. Yet in less than one month of
NBE therapy, her headaches, back pain, bladder and pilonidal cyst problem were
greatly reduced.
In
addition, she noted to her pleasant surprise, that her problems with chronic
fatigue, sinuses, complexion, digestion since her teens, mental concentration,
clarity, and memory, all have improved significantly. She stated her mind was
working at the highest efficiency, and she was able to return to full time
employment.
Here
is a patient who has failed with the conventional system, while obtained instant
success with ours. A simple call to her would have easily verified this fact.
Instead, you consult those who have failed, while ignoring the one who has
succeeded. Does Blue Shield resolve its financial or other problems with a
similar approach?
Let
me explain another reason for my success. For the initial visit, I spend over an
hour to educate my patients (you can call my patient to verify this) on the
mechanism of my therapy. In addition, I explain the lifestyle root causes, which
result in the breakdown of their body functions, and recommend lifestyle
adjustments for prevention.
Because
Cookie was so depleted of her energy due to the toxic drugs and her chronic
illnesses, I had to provide extra injections for most of her initial treatments.
For this superior patient care, true prevention, and great cost saving for Blue
Shield, you reimbursed us a mere $50 for 15 treatments!
All
of my new patients are informed that they have to pay the unconventional part of
my therapies, which Blue Shield does not cover. Your denial in effect places the
financial responsibility entirely on the patients. No insurance company ever
refunds anyone for staying healthy and not using their benefits, but when a sick
person requires long-term treatment, all kind of reasons are used to deny
payment.
It is bad enough that the ineptitude of physicians has caused much suffering and damage to the sick, forcing them to seek and pay from their own pocket for alternatives, few of which are truly effective. When they find something helpful, physicians deny them by twisting the meaning of medical necessity with fallacious research!
Even
though the randomized controlled experiment is scientific, the fallacy is that
it is used to affirm invalid palliative
band-aid therapies. Secondly, all substances have a particle (material) and wave (energetic)
aspect. Current research methodology ignores the energy variables, and hence is not truly a controlled trial.
Unfortunately,
truth is not the motivating factor in medicine. Money is. In spite of my
remarkable results, mainstream journals have been reluctant to publish them. And
medical reviewers utilize this fact to deny our services in an attempt to
preserve the status quo. As a
result, the truth is buried and the people continue to suffer.
For
instance, Jeff K. (ch) was an 18 year old with unrelenting depression, who came
to me after a failed suicidal attempt by swallowing a bottle of Paxil. He had
tried all kinds of drugs and psychotherapy as well as religion, hobbies, and
exercise, all to no avail.
His
depression was much improved after his first NBE treatment, and essentially gone
after 18 treatments. However, his insurance refused to pay for our service.
Three years later, a relapse of symptoms from stress forced him to go back on
the same nonsense that had never been effective for him, and his insurance paid
for it.
Another
example, Carole K. (pi) came to us from Pennsylvania with a history of 14 years
of relentless pain from two failed back surgeries. Nothing had helped. Again,
the first NBE treatment provided much relief. Yet her insurance refused to pay,
and she received only a few sporadic treatments. Currently she is in litigation
with her insurance.
Yet
another patient, Billie F. (letter, pi/ch), came to me recently with a diagnosis
of syringomyelia, a condition characterized by multiple cavities in the spinal
cord. This elderly lady has been wheelchair-bound for 14 years, but able to limp
painfully with a brace and walker at home because of periodic acupuncture
therapy.
Although
she could tolerate only a partial NBE treatment the first time, she felt some
relief. Amazingly enough, her second treatment enabled her to walk and climb
stairs without pain, her brace and walker for four days! (See her letter to Dr.
Streebig.) Despite this phenomenal result, her insurance disallowed our
treatment, and sent the case to the Orange County Medical Association (OCMA) for
arbitration!
A
member of the OCMA committee, Dr. Parson, called me four months ago, and I told
him about a similar case denied by the OCMA many years ago. Pam G. was disabled
from a failed back surgery, and refused to have a second one. NBE treatment was
the only thing that helped her, and in fact enabled her to return to work in
three months. Her insurance, and later the OCMA, ruled that our therapy was not
necessary!
Dr.
Parson was initially sympathetic and said that perhaps the physicians did not
understand my treatment. Yet how do physicians have the right to deny a
beneficial treatment just because they don’t understand it? What if they do
not want to, or take a long time to understand it? Must the patient continue to
suffer in the mean time?
Last
week OCMA denied Billie our therapy! Dr. Parson explained that even though I
have presented my findings in a symposium, which were supported by a study of
1000 patients with a wide spectrum of disorders, the OCMA committee did not feel
that there is enough evidence to warrant the NBE therapy!
This
is unjustifiable! Not only is my therapy harmless, but it has already
demonstrated remarkable results on this patient. Moreover, There is no cure for
syringomyelia by allopathic medicine, nor is there much interest to research
this rare disorder. The OCMA action in essence has sentenced this poor lady to a
life of agony -- as if 14 years of pain is not enough. How a group of highly
educated physicians can be so unkind is beyond my comprehension.
Let
me further substantiate that the core of the matter is the conflict of interest.
During the past ten years, I have had similar problems with reviewers from
Medicare. The first instance involved a paraplegic patient, Dan T. (ch) who has
failed two back operations and numerous therapies over ten years, ending up
vegetating in bed for two years.
Although
three years of NBE treatments enabled him to return to full time school and
become chief editor of the school newspaper, Medicare deemed that they are not
necessary. However, an administrative judge on appeal ruled 100% in our favor.
The
second time involved an audit of a group of patients. Medicare made a similar
decision and demanded $60,000 from us for unnecessary services. Another
administrative judge again rule overwhelming for us and allowed only $500
payment to Medicare.
Another
example is Alex R. (pi), who had injured his back at work. Back surgery was
recommended after 10 months of deteriorating symptoms despite aggressive
orthodox therapies. Alex refused the surgical route, and requested permission
for my treatment on the referral of one of my patients, who had avoided a back
operation due to our therapy.
The
orthopedist disapproved his request. However, I convinced the insurance adjuster
that there would be a good chance that I could provide immediate relief, and
possibly allow the patient to return to work in 6-8 months. The patients did get
instant relief, and was able to return to full-time employment in 6 weeks
instead of 6-8 months!
I
shall provide one final illustration that is somewhat tragic. A 16 year-old Blue
Shield patient, Gad K., had a six-year history of grandmal seizures, averaging
5-6 a day, but had occasions when he needed 11 emergency room visits in one day.
He had consulted at the most well-known institutions in the world. Yet all the
advanced conventional therapies, including the ketogenic diet, failed to produce
any improvement.
In
contrast, his first NBE treatment stopped the seizure for three days! Further
therapies decreased his seizures to a few times per month, while reducing his
medication! Despite this incredible outcome, your reviewers decided that our
therapy was not necessary.
Similarly,
the neurologist at the Children’s Hospital at Los Angeles did not persuade the
insurance to allow continued NBE therapy, despite the improvement it had
produced. Instead, neurosurgery was performed on Gad, and he suffered severe
neurological symptoms requiring extensive therapies. We were told that the cost
of the operation and post-op complication was more than $250,000!
I
am certain that the expenses for his on-going care are astronomical and endless.
Does it make sense that you would avoid paying us a few thousand dollars,
especially when we had achieved such remarkable improvement on him that no one
could?
In
all these cases, physicians who had objected to our therapy were preoccupied
with self-interest. On the other hand, those who had favored our therapy
considered the welfare of the patient by observing the evidence. They were not
biased because there was no conflict of interest.
Notwithstanding
the validity of my argument, we acknowledge your concern regarding our
documentation. For this we now require all new Blue Shield patients to bring in
previous medical history and records, and have each regularly completed a
“progress report” to document their improvement.
However,
the necessity of treatments in these cases is evident from the fact that these
professionals would take time from their busy schedules, drive long distances to
receive and pay for unpleasant injections mysterious to them. And the fact that
they return for more as well as refer their love ones to us indicates that the
treatments are beneficial.
Most
importantly, treatment reimbursement should not be based on spurious research on
symptomatic modalities, but rather on health improvement of the patients, such
as reduction or elimination of drug requirement and the increase of physical and
mental functional capacity.
Finally,
insurance benefits are money paid by the insured. A third party has no right to
dictate how they can utilize these benefits. Imagine an equivalent situation in
the food industry, where food doctors can control food insurance benefits and
approve what you can or cannot eat; and to prohibit food that you find
beneficial, or to force you to eat what you find disagreeable. People would
rebel!
We
have such an absurd system in medicine, and millions are suffering as a result.
Consider the myriad of degenerative ailments we have today that we did not have
only a few decades ago. Cancer, for example, was a topic limited to the medical
community and mostly restricted to the elderly. Today, everyone knows someone
who has died of cancer, and it is afflicting all ages.
Examine
the e-mails on my web site. Many are heart-wrenching tales of agony and despair,
aggravated by the ignorance of callous medical practitioners. Is it not time
that the medical profession places its priority on the sick over its
self-interest?
A free market is the only solution to our health dilemma
The
fundamental flaw resulting in our health care mess is that American citizens
have lost their free choice of medical care due to a monopolistic system. Their
insurance benefits are controlled by a profession that is more preoccupied with
preserving self-interest than to meet the patients’ goal, which is to have
their sickness cured.
Consequently,
medicine, unlike other industries that cater their work to the need of the
customers, provides little reward for curing diseases. Instead, there is
enormous profit in suppressing symptoms through drugs and surgery, in patenting
drugs, vaccines, and genetic innovations, and conducting research that conforms
to current orthodoxy so that the people behind these special interests would
profit from the result.
Insurance
companies, such as Blue Shield, have to foot some of these wastes initially, but
can easily pass on the costs to the patients in the form of premium raises or
denial of benefits. The patients ultimately suffer in this scenario.
I
am writing this extensive letter in the hope that you, as a physician and the
director of a big insurance company, have enough foresight to understand what I
have presented, and to envision possible improvement of this truly rotten
system. I am making the following proposed experiment with Blue Shield, which
will benefit everyone and prove my point.
I
propose that you refer us a group of patients with chronic disorders for which
surgeries are being considered. The best would be expensive operations, such as
coronary bypass, back surgery, hysterectomy, or other costly conditions. Our
current data indicates that:
1.
Over 90% of the patients improve with the first
treatment.
2.
Over 90% do not need the recommended surgery.
3.
Most are be able to reduce or eliminate their medications from the
beginning.
4.
No expensive diagnostic tests are needed.
5.
All ailments are treated, reducing the need for other specialists.
6.
Progress is monitored using regular reports showing objective
improvements.
7.
The total cost of the NBE approach is a fraction of that of orthodox
method.
Blue
Shield cannot lose with this proposal. A patient normally stops treatment if
there is no improvement, which occurred with two of the patients being
questioned, where each had only one treatment and did not return for further
therapy. All patients, however, should be encouraged to try several treatments
before deciding to discontinue.
To
my knowledge, there is no one in the medical field who can accomplish similar
feat for such a wide variety of disorders, and can cure them. I am firmly
convinced that our experiment will prove to be the prototype for a root cause
solution to our health care crisis. Please do not dismiss this proposal without
first examining the interviews and cases on my web site. I have thousands of
them.
I
believe that an owner of your company would consider giving this experiment a
try because of the potential enormous savings. Therefore, I respectfully request
a written reply from an executive of Blue Shield who deals with company profits.
I would like to quote the response and the experimental result in a book I am
writing.
In
the mean time, I feel that I am entitled to reimbursement for therapies that I
am qualified to provide as a physician. I know Blue Shield pays other physicians
for trigger point injections. Trigger points are acupuncture points. I achieve
great result because I know their physiological implication from Chinese
medicine. Those lacking this knowledge have no idea of what they are doing. It
would be ridiculous for Blue Shield to pay them and not me.
Please
expedite the payment being withheld on the various patients. Also included is a
list of other patients which you have withheld payment in the past. Progress
reports documenting improvement on most of these patients are also attached.
Finally,
consider raising our reimbursement. The greatness of America is ground on a free
enterprise that encourages efficiency. Our health dilemma cannot be resolved by
rewarding failure more than success. A little calculation will show that our
cost is only a fraction of your past expenditure on these patients, not counting
future expenses we would have saved you.
I
am looking forward to a reply from you and your executive.
Sincerely,
Yee-Wing
Tong, M.D.
Encl.