Category Archives: Pesticides

Insurance – “Medical Necessity” Requirement Part 2

Services:  What does the requirement of  meeting “Medical Necessity” mean? 

What it does not mean is what your doctor thinks is beneficial or necessary.  No, the insurance company decides if recommendations meet community standards which are encompassed in the field of traditional medicine or medical literature reviewed by peers only.

If you see the doctor for a condition or illness that does not include a primary diagnoses, the service cannot be billed at a level that meets coding requirements and will be denied.

Conditions such as yeast infections, depression, anxiety, psychiatric codes, heavy metal burden, multiple chemical sensitivity, erectile dysfunction and many others are not primary diagnoses codes.  Irritable Bowel Syndrome is a primary code (criteria must be met for this as with diarrhea and constipation.)  Gas and bloat are not primary.

Some patients arrive at the doctors office with a short list, wanting only a specific condition addressed.  When this happens, it may automatically set the course for denial by the insurance company.  The insurance company wants to see primary diagnoses codes which are define by a coding standard.  Requirement for correct billing is an appropriate ICD-9 code or billing code and a primary CPT code.  

Uncovered codes are patient responsibility if waiver is signed.  Before you leave the clinic with a laboratory test, we will provide you with the cost of the test and the extent of what we believe your insurance will pay.  That amount will be collected at the time of service.   We cannot guarantee your benefit amount because your insurance will not guarantee the information received when we call and verify benefits.  They state and our business agreement states that you solely are responsible for bill regardless of your insurance coverage.

Sample Profiles (list not complete for covered and uncovered tests):

Pesticide Panels:   You must provide a payment for the total billed to the laboratory.  We can then bill your insurance company, later refunding you if coverage is accomplished. 

Amino Acid Assays, Nutritional Based Assays-most insurance companies do not pay these items, however, through an agreement with the laboratory, we can accomplish quality assays for amino acid serum, RBC mineral, organic acid and fatty acid profile for a very low cost.

Genetic Testing-.While this is not a covered expense at this time, there is talk that it may be in the future.  You should consider, if that benefit becomes available, the consequences your genetics may have on life insurance, for example.  

Comprehensive Detoxification Panel:  Portions of this tests are not covered by insurance, therefore, unbilled portions are paid to the patient.  We notify you what we believe your responsibility will be.

DMPS Chelation Therapy and Metals Challenge Test-Does not meet medical necessity and is therefore paid by the patient.  See next segment.

EDTA Chelation Therapy and Metals Challenge Test-We use this therapy for reducing specific heavy metal burden.  Because the conditions we treat are due to chronic exposure, only on rare occasions does insurance ever pay.  Payment is always due date of service.  Toxicity is defined by blood test only and is rarely seen in patients with acquired body burden.   The appropriate test in this case usually will not qualify you to meet medical necessity.  Payment in full is required by the patient.

Environmental Pollutants-We will not bill for this service as most of it is not covered by insurance, therefore, paid in full by the patient.

Food & Inhalant Testing-covered if qualified.  Qualifying a patient includes ages under four, autoimmune disease and chronic skin conditions such as eczema or psoriasis where the doctor believes skin testing may worsen the condition, chronic use of antihistamines without benefit and steroid use.

Hair Analysis-We will not bill for this service as  it is not covered by insurance, therefore, paid in full by the patient.

Vitamin Mineral IV’s-generally not covered and PPO insurances requires that you provide documentation after the service is performed to see if it meets medical necessity.  Therefore, we require payment upfront with a waiver.  In almost every case, insurance does not cover. 

Nutritional Consults by Certified Nutritionist-typically uncovered. 

Other tests such as the ION and TRIAD panel by Metametrix is payable in advance.  We will then bill your insurance company and refund any portions paid.  

Stool Testing:  Payable if criteria is met.

Center for Environmental Medicine

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Heavy Metal Burden-Cadmium, Lead, Mercury Plus More

In the toxic environment we live it, it is hard to imagine one being able to escape the potential dangers that threaten us in our air, water and food.  Some believe, as I do, that the health of this nation, evidenced by the escalation of heart disease and chronic acquired diseases, is in direct relationship to the accumulation of the toxins within.  High levels of metals, drugs, and manmade compounds can be found in our environment.
 We hear about the effects of global warming more than we hear about how toxins are dismantling this nation of its richest resource–health.  As stewards of this earth and our bodies, we need to understand the problem and do our part to protect our families, community and self.  We aren’t hopeless or helpless in this age of information unless we choose to be. 

 Heavy metal burden is the unintended consequence of industry worldwide dating back to the Industrial Revolution in the 1700’s.  The economy that was created unquestionably changed the world…and it is still changing our world today.  The cost of healthcare continues to rise and some believe that the collection of heavy metal entities in the body contributes to acute and chronic disease, primary introduced into the body by oral or inhalation means.  Cadmium is the most toxic element to man, then lead, then mercury.   Toxins that are manmade chemicals contribute as well.  Little is considered as people wash with scrubs or work with unprotected hands in harsh chemicals.

The economy of healthcare is found in the treatment of disease.  While an enormous amount of money annually goes to research, the title of drugs is at the top of the lists.  One thing for sure, there is a drug for almost everything.  Illness is sometimes considered a synonym for disease or sometimes viewed as the subjective perception of the patient or an objectively defined disease.  If the objectively defined disease is illusive, then the problem exists only in the mind of the patient. Or does it?  

Environmental doctors and those interested in prevention of disease take a different look at the disease model. First, they consider the patient might be right!  Their symptoms might actually be an underlying cause even thought the cause may be illusive and unrelated to emotional or mental illness.   You don’t have to be a doctor or struck with illness to share wisdom.  It is easier and less expensive to prevent disease than to treat it. 

The alternative doctor looks at the body and sees it wondrously made. Food and nourishment is required to fuel and maintain the machine.  The cleaner sources the food comes from, and the more nutritious the source, the better.   If the body is unable to function properly because of enzyme and nutritional deficiencies, should you add a drug to make the process happen or inhibit another process to provide an artificial balance?  In alternative medicine, the practitioner strives to restore the balance.  Removing a toxin is preferred to adding a drug and reasonable nutritional support including a healthy diet. 

One area of alternative medicine many patients have benefited is detoxification programs including those specifically designed to remove xenobiotics (manmade chemicals including plastics and pesticides) and chelation for heavy metal burden.  A healthy BMI (body mass index) is important because toxins store in fat.  If your attitude reflects little dedication for long term effects of healthy living, then you need read no further.  If you understand investing in your health has long term rewards, then you should consult a trained practitioner in chelation to get the best care.

 For example, some professionals use blood tests but results reflect recent exposures and typically not chronic exposures. Others use hair analysis which typically reflect chronic exposure but not body stores of toxic metals.  Fecal tests can be influenced by dietary and metabolic factors.  Challenge tests may fail to produce an expected response in glutathione deficient patients, provide the best results for elevated and very elevated levels.  The challenge test, with the preferred chelator,  is the preferred test.  Often multiple toxic metals are present and increase the duration of the chelation processEach additional toxic metal lowers the toxic threshold for every other metal resulting over time in dysfunction of multiple organs and tissues, impaired chemical detoxification, excessive free-radical formation, and chronic conditions such as chronic fatigue syndrome and fibromyalgia.  Also, increased oxidative stress, related to elevated heavy metals may precondition you for heart disease.  

The impact of how heavy metal burden affects a person depends on their sensitivity. Type O blood patients seem to provide few symptoms and these are the patients who take the least care of themselves because they “feel fine”.  “Feeling fine” does not necessarily reflect the truth which is why health checkups are important.  Areas of concern may be when you see elevations of cholesterol, dysfunction of blood sugar, mental confusion and fatigue.  For example, trace mineral depletion is caused by disruption of transport by heavy metals competing for receptor sites on transport proteins and metallothioneins and by binding sulhydryl groups on many enzymes.  This process may be so gradual, you may fail to recognize the onset of persistent fatigue, decreased mental acuity, or increased issues with metabolism, yet your doctor may not know how to test for these or why they might be important.  In contrast, the type A blood patient is very sensitive and notes many more symptoms because they tend to be more sensitive to their environment.

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Termite Extermination-Informed Consent

Pesticides kill insects and pests but can also have a devastating effect on the human species.  When a panic-stricken friend called to say she had a termite infestation and the exterminator wanted to pour 350 pounds of pesticide in and around her home, I realized most people do not know how to get enough information for informed consent.

Termites not only eat the wood structure of your home but can penetrate the soil and lay eggs.  A contact pesticide, the safest form of pesticide will not reach the target areas which are the nest and eggs and the queen termite nor protect your investment.   Often at least two persistent pesticides are recommended to resolve the problem.  They are called persistent because they linger in the environment and can be toxic to birds, aquatic and wildlife.  The mechanism of action to kill the pests is by affecting the nervous system. 

Suggested research:

FIND the Material Safety Data Sheet on line. 

GOOGE search: product name MSDS

Wikipedia is a good source for information on any subject

Also read material on line about each product suggested by your exterminator. 

Termidor is a persistent pesticide.  One of the most recommend products for termite control and extinction is Termidor.  The active ingredient (fipronil) is about 0.06% of the solution.  The concentration is much lower than most insecticides and has virtually no odor.  The termites cannot see, smell or taste the product and therefore do not avoid it.  The product is engineered to be slow-acting so once they contact, ingest and share it with their nestmates, the problem is well on its way to being resolved.

Pyrethroid pesticide is a contact pesticide.  One of probably the safest of all the pesticides is Bifenthrin.  It can be used indoors including food handling areas like restaurant kitchens, on and around building exteriors, plants and lawns.  It is a synthetic pesticide comparable to the natural pesticide pyrethrum which is made from chrysanthemum flowers.  It is not harmful to pets when dry, but has been found to be moderately toxic to birds and highly toxic to fish.  Plants do not absorb this pesticide.  Mechanism of action is by paralyzing the central nervous system and is effective as a contact pesticide for spiders, mosquitoes, cockroaches, ticks and flears, pillbugs, chinch bugs, earwigs, millipedes and termides. 

Tim-Bor & Borrada D are inorganic borates.  These products are used as wood preservatives to stop and prevent rot and insect attack. They are water soluable inorganic borage salts with insecticidal and fungicidal properties.  These borates are effective against subterranean, dry and damp wood termites, carpenter ants and Powder Post beetles and more.  The mechanism of action is a slow acting stomach poison and contact poison to decay fungi.  As a wood preservative, the insects or larvae feed on, tunnel or digest wood thus accumulating the active ingredient.  This is not the first choice for treatment.  This product protects from decay fungi as well.

Imidacloprid-Imidacloprid is a chlorinated neonicotinoid insecticide that acts on the nicotinic acetylcholine receptor which inhibits degradation by acetylcholine-esterase.  It has relatively low toxicity to most animals other than insects due to the specific receptor named above and is a topical treatment for dogs and cats for fleas.  The product breaks to inorganic molecules in water and soil and therefore is not considered a persistent pesticide but is reported to degrade into toxic, persistent, 2-chloropyridine.  It can stay in the environment for 2.75 years.  In the body 96% of the chemical is eliminated in 48 hours.

To help avoid infestation, remove all loose wood from under the house and keep the area dry. 

Other pesticides may be recommended by the exterminator.  Do your homework and make an informed choice of remedy regarding the problem of termite infestation.   

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DDT, DDE, DDD, DDA-Organochlorine Pesticide

DDT, DDE, DDD, DDA-Organochlorine Pesticide                                      Part 1 

DDT is an organochlorine insecticide that was first synthesized in 1874 and was a commonly used pesticide in the United States on crops and in buildings until 1972 when it was banned from use.  It was banned in Mexico in 2000 but is still used in Africa, South America and Asia to control malaria and other pests. DDT is still manufactured in the US but sold only to foreign countries but there is the exception for DDT for public health emergencies involving insect disease and lice. 

DDT is persistent in the environment, accumulates in fatty tissues and some pests can build resistance to it.  While stored in fat, it produces no noticeable symptoms. It affects the nervous system by interfering with normal nerve impulses.  Mammals exposed to DDT develop liver tumors an have increase risk of liver tumors but there is not sufficient study to demonstrate that it is carcinogenic in humans. 

DDT breakdown products in the body include DDE, DDD and DDA.  It is excreted in the urine, feces or breast milk. It tends to accumulate in animals but has declined with discontinued use.  The soil half-life is 2-15 years, and 150 years in the aquatic environment.  

DDT is dichlordiphenyltrichloroethane

Organochlorines are chemical compounds that contain hydrogen, carbon, chlorine, and possibly other atoms.

DDE is dichlorodiphenyldichloroethylene-breakdown product of DDT

DDD (DDT) is dichlorodiphenyldichloroethane

DDA is 2,2-bis(4-chlorophernyl)-acetic acid

Center for Environmental Medicine

Pesticides – Effects on Children

Our children seemingly have chronic exposure to pesticides from the womb to the grave.  Over a lifetime, with approximately 4.5 billion pounds of chemicals applied annually to crops, buildings and lawns in the United States, is it any wonder chronic illness in on the rise?  Reports of 50% intake of pesticide exposure occur within the first five years of life.
Additionally, some tests indicate vulnerability to pesticide up to three months before pregnancy and the first month after conception.  As if this isn’t enough, many pesticides detoxify through mother’s milk either as pesticides or their metabolites because the milks fat content causes the solubility of the toxin.  The developing brain and central nervous system have pronounced vulnerability to neurotoxicants such as lead, mercury, alcohol, other than pesticides and causes reason for concern.
While the overall use of pesticides decreased 17.2 % from 1979 to 1997,  that has little affect on children 6 years and younger who are much more susceptible to pesticide toxicity because they eat more, drink more and breathe more per body weight.  Children are physiologically different than adults because they grow rapidly requiring more energy Their activities of ground playing and water activities put them at greater risk for heavier exposure to pesticides in water, soil, and air.
Multiple pesticides may be present at the same time in mother’s milk and consequences may include altered social skills, decreased intelligence, and reproductive difficulties or failures.  Thyroid function in pregnant women is a critical determinate in IQ and some persistent pesticides such as polychlorinated biphenols and dioxins disrupt thyroid function.  In animal models studies have shown a variety of pesticies such as DDT/DDE, mirex, aldrin, dieldrin, atrazine, dieldrin, atrazine, hexachlorocyclobexane, toxaphene, alachlor, chlordane, vincloxolin and chlorphyrifos can interfere with estrogen androgen and thyroid receptors during critical periods of development.  Additionally, pesticides can affect neurotransmitter metabolism and electrophysiological actions. 

It’s important that we learn how to protect our kids and because certain pesticides such as DDT and DDE have a half-life of about 150 years in aquatic environments, seafood may be one of the easiest exposures to avoid.   Getting a child use to a good distilled fish oil high is DHA early in life is probably one of the best things you could do as it mobilizes many pesticide toxins out of the body but is also great for brain development, skin and liver function. 

Today there are sophisticated tests for pesticide residue of all kinds, which require a simple blood draw shipped to the laboratory. 

http://es.epa.gov/ncer/childrenscenters/pesticides.html

Center for Environmental Medicine