The International Society of Neurofeedback (ISNR) petitioned state Attorney Generals to commence a “restraint of trade action” against health Insurance Carriers in June 2009. The author(s) of the letter put forth a strong rationale for mandated insurance coverage of neurofeedback / biofeedback, including that insurance carriers hold neurofeedback / biofeedback efficacy research to a higher burden of proof. Below you will find a copy of the original letter sent to the Attorney Generals, as well as ISNR’s recent update on the responses received so far. The initial Attorney General feedback suggests that ISNR will have significant hurdles to overcome with this legal approach.
Here is the sample letter released to the general public:
June 1, 2009
NYS Attorney General
Albany, NY 12234-0341
Dear Mr. Cuomo,
We are writing on behalf of the members of our organization to request that you commence a restraint of trade action against health insurance carriers doing business in New York State for their refusal to provide coverage of biofeedback and neurofeedback for their subscribers.
It is our understanding that restraint of trade includes contracts designed to establish a monopoly position, impede competition, fix prices or prevent entry by potential rivals. It includes hampering or obstructing the course of trade and commerce as it would be carried out if left to the control of natural economic forces and is considered contrary to the public interest.
Biofeedback uses sensitive electronic instruments to measure a patient’s physiology and to feed back that information to the patient in order to teach the patient to control his physiology. Neurofeedback, also known as brain wave biofeedback or EEG biofeedback, is biofeedback focusing on altering the electrical activity of the brain in order to improve brain function. Biofeedback and neurofeedback have been in use in the United States for over 40 years. The treatment is usually provided by licensed health care professionals, or professionals with advanced health related degrees, including M.D.s, psychologists, social workers, marriage and family therapists and nurses, many of whom are also certified by a national organization, the Biofeedback Certification Institute of America (BCIA).
Hundreds of studies have demonstrated the safety and effectiveness of biofeedback and neurofeedback for treating a wide range of conditions which include: ADHD, addiction, anxiety, autism, bipolar disorder, chronic fatigue syndrome, chronic pain, depression, fibromyalgia, headaches, posttraumatic stress disorder, seizure disorders and traumatic brain injury. For many people with these conditions, other available treatments have been woefully inadequate in alleviating their suffering, and these conditions account for the vast majority of the 1 in 6 American adults who are too disabled to work or carry on normal activities of daily living.
Most health insurance companies as well as government insurance programs currently refuse to cover any type of biofeedback on the grounds that it is “investigational.” Their stance completely ignores that fact that 85% of conventional medical treatments have never been proven effective to the standard of evidence currently being demanded of biofeedback: randomized, controlled, double blind studies.
Many conventional treatments are also extremely dangerous. The FDA’s Office of Drug Risk Assessment estimates that only 1% of adverse drug events (ADEs) are reported. Still the official toll is that 2.2 million Americans are hospitalized every year due to adverse drug events and over 100,000 die. 9.7% of ADEs result in permanent disability. Recent figures from the FDA estimate that the cost of treating ADEs is from $20 billion to $75 billion a year. That does not include the cost of the drugs themselves, most of which have to be taken for a lifetime.
In contrast, biofeedback and neurofeedback have no adverse effects. In fact, overall quality of life tends to improve, as many other conditions not being specifically being targeted by the treatment often also improve. In addition, biofeedback and neurofeedback treatment are usually given over a period of a 3-6 months, and then the benefits are permanent, thus significantly reducing treatment costs over time.
Americans deserve the right to choose their health care treatments, especially when the choice is one that is safer, more effective and lower cost than the usual treatment. While thousands of New Yorkers are making the choice to get biofeedback/neurofeedback treatment, despite the out of pocket costs, many more who would benefit from this treatment are unable to access it due to lack of insurance coverage.
Members of our organization would be glad to meet with you to provide further information or to answer any questions you might have.
Thank you for your attention to this matter.
ISNR announced this week that they received several responses, stating that “The Attorneys General from Oregon, Tennessee, Oklahoma, Washington and Utah have responded to our letters to their offices suggesting that third party payers are engaging in restraint of trade when they refuse payment for biofeedback. Unfortunately, they mostly say that we would have to prove that there is a conspiracy, that there is a law in place that demands such coverage and/or that this matter may be better taken up with the Boards of Consumer Affairs and/or the insurance commissioners of each state. We will keep you informed as to how the Public Relations and Government and Professional Affairs Committees follow-up.”
It appears for now that no legal action will be taken against insurance companies, at least in the states mentioned above. ISNR and their officers are commended for this bold and important effort.