Appeal type: Experimental/Investigational
Decision: Upheld Decision of Health Plan

Physician 1The patient is a 64-year-old male with peripheral neuropathy and peripheral vascular disease. The patient reports he has chronic pain and numbness in his extremities and has difficulty sleeping. The patients provider has recommended the patient undergo Anodyne therapy. The Health Plan has denied authorization for Anodyne therapy on the basis that it is considered experimental.Anodyne therapy is an unproven mode of physical therapy that lacks validation. It allegedly works by facilitating nitric oxide release. The efficacy of Anodyne therapy has not been established through significant, case-controlled studies. There is no evidence that Anodyne therapy is likely to be of greater benefit to the patient than standard treatment modalities. Therefore, I have determined that the requested therapy is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.Physician 2The patient is a 64-year-old male who has requested authorization and coverage for Anodyne therapy for treatment of peripheral neuropathy. The patient experiences chronic pain and numbness in his extremities. He has failed treatment with Neurontin and custom molded orthotics. The Health Plan has denied authorization for Anodyne therapy on the basis that it is considered experimental. The Health Plans denial should be upheld. Though the patient has been diagnosed with neuropathy, there is no evidence that the patients diagnosis has been further qualified. Furthermore, a review of current medical literature failed to identify any randomized controlled trials focusing on Anodyne therapy. There is insufficient peer-reviewed literature to show that Anodyne therapy as compared to standard therapy is more beneficial. Therefore, I have determined that the requested therapy is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.Physician 3The patient is a 64-year-old male with peripheral neuropathy. The patient has chronic pain and numbness in his extremities and difficulty sleeping. The patient has been tried on Neurontin and custom molded orthotics without success. A request has been made for authorization and coverage for Anodyne therapy. The Health Plan has denied authorization for Anodyne therapy on the basis that it is considered experimental.Review of current medical literature demonstrates that Anodyne therapy has not been systematically studied. There is insufficient data establishing the long-term efficacy of Anodyne therapy. As such, Anodyne therapy is not indicated for treatment of the patients condition since it is not likely to be more effective than standard therapy. The cause of the patients neuropathy does not appear to have been thoroughly investigated. Finding the underlying cause of neuropathy is imperative since treating the underlying cause frequently leads to marked improvement of the pain caused by neuropathy. Though conventional therapy with Neurontin appears to have been ineffective for this patient it may be that the prescribed dosage (300mg per day) was insufficient. Some patients achieve relief with up to 1300mg of Neurontin in divided doses per day. In any event, it appears further workup is needed in order to determine the etiology of the patients neuropathy. Based upon the information set forth above, I have determined that the requested therapy is not likely to be more beneficial for treatment of the patients medical condition than any available standard therapy. The Health Plans denial should be upheld.