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My son has recently been diagnosed with stage 3b/4 chronic kidney disease

Q. My son has recently been diagnosed with stage 3b/4 chronic kidney disease. He would like to use acupuncture to help him through this challenging life changing period. Our insurance will cover the costs of this type of treatment.

However, he is unable to get a Doctors note to support this type of treatment either from his GP or from his kidney consultant. Therefore he cannot make a claim from our insurance.

How can I arrange a consultation with a doctor to support his acupuncture treatment?

A. We are very sorry to hear of your problem. We have seen this a number of times where the insurer is apparently happy to cover acupuncture as an option but requires the GP or consultant to act as a gatekeeper in providing a referral letter. We are not sure which scheme provides your cover, but we are aware that the scheme providers are wary of writing a blank cheque to scheme members for treatment where there isn't an agreed protocol which offers a realistic chance of success within a fixed number of treatments. Traditional acupuncture, which is as much about maintaining health as it is repairing damage and disease is potentially open ended and contextual, i.e. the same problem occurring in twenty people might arise from twenty different causes, some of which might respond quickly and some of which might not.

Since the schemes are created on an actuarial basis, where the provider has to have a realistic idea of what the commitment is, then the doctors and consultants are often instructed only to refer those patients with conditions for which there is a goof evidence base and standard treatment. This reduces the number of referable conditions dramatically.

It may be possible to locate a doctor who is prepared to refer your son; many private hospitals have GPs who are able to see patients at a price. Whether this would count as a referral is another matter; there's no point in spending £100 for a letter which your insurance company will repudiate anyway. We have seen patients whose companies have larger schemes which they control use this as a bargaining/blackmail chip by threatening to pull all their staff our of the scheme and go elsewhere, but this does have the disadvantage of a fresh start for people with pre-existing conditions whose cover lapses immediately.

We have found that talking directly to the insurance providers is often the best bet, both for throwing yourself on their mercy and also for finding opportunities within the system which you might be able to use to your advantage. Companies are run by human being who are often predisposed to help.

Another option is to use the PALS (Patient Advisory Liaison Service) which, in our experience, is pretty effective at fighting patient's corners. If you son is under hospital supervision, which we are sure he is, then this may well be worth a go. it won't be costing the hospital a bean, and consultants do not generally want the hassle of people nagging them when they might be shown to be unsympathetic. At very least it offers you something concrete about why they are refusing to sign, and that gives you are starting point for further negotiation.

There isn't a great deal of research we can point you to to support your case, and studies such as this

are few and far between. However, if you do get to a point where evidence might help to sway someone's mind then we will do what we can to help you.

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