Madison Area Lyme Support Group

Article Excerpts:

(CN) — A group of Lyme disease patients asked the Fifth Circuit on Thursday to revive their lawsuit against a medical society they claim issued bogus guidelines that insurers used to deny them coverage, forcing some to pay hundreds of thousands of dollars for their care.

Lisa Torrey and 27 others sued the Infectious Diseases Society of America, or IDSA, seven health insurance companies and several medical doctors in 2017 in Texarkana, Texas, federal court.

Bringing RICO Act and antitrust claims, the plaintiffs claim several major health insurers decided treating Lyme disease was too expensive, so they paid IDSA-affiliated doctors to establish arbitrary guidelines, first published in 2000, that said the illness could be treated with 28 days of antibiotics.

After reaching confidential settlements with the insurers, the plaintiffs filed a second amended complaint in January 2021, adding fraudulent and negligent misrepresentation claims against the IDSA and its panelists who wrote the guidelines. (See link for article)

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SUMMARY:

• A U.S. District Judge sided with the IDSA and dismissed the case
• Although appealed, the IDSA convinced the appellate court to dismiss it as premature since the settlement hadn’t been finalized
• The plaintiffs filed another appeal and a 3-judge panel of the 5th circuit heard arguments recently
• The judge is leaning toward dismissing the lawsuit as it is about a scientific issue that needs a forum for debate
• The challengers’ lawyer made the argument that more than 12 states have passed legislation to protect physicians’ ability to prescribe long-term treatment proving that in reality doctors are bound by IDSA “guidelines,” as well as the fact insurance companies hide behind these “guidelines” which have become mandates allowing them to deny payment for treatment