Paying for the Unorthodox Treatments in Tijuana

The voice on the tape recording sent to prospective patients is deep, unctuous and reassuring as Harold W. Manner gives another good reason to seek treatment at the Tijuana medical clinic that bears his name.

“Our program has been so well accepted throughout the world that most major insurance companies in the United States and the provincial insurance companies of Canada are now covering us to the limit of the policies,” Manner says.

“This is very important,” he adds, “because it means that we have been recognized by the major institutions of these two fine countries.”

Indeed, major health insurance companies are paying millions of dollars a year in claims filed for visits to Tijuana clinics that cater mainly to Americans and offer wildly unorthodox treatments that reputable medical experts say are worthless and sometimes dangerous.

But insurance companies honoring these claims usually do not realize what they are paying for, according to James Garcia, a top Aetna Life Insurance Co. official and head of the National Health Care Anti-Fraud Assn.

Health insurance policies normally contain clauses that specifically exclude coverage for treatments that are unorthodox and not medically accepted practices.

But Garcia alleges that these clauses are often circumvented by a Houston company--North American Health Insurance Coordinators (NAHIC)--that processes the insurance claims for nine Tijuana clinics. Garcia has sent his findings to the office of the U.S. Justice Department’s Organized Crime Strike Force in Houston, which, The Times has learned, is conducting an investigation into insurance claims connected with the Tijuana clinics.

The strike force will neither confirm or deny that an investigation is taking place.

NAHIC defends its processing of insurance claims and denies any impropriety.

Patients at the Tijuana clinics usually are required to pay in advance for the treatments that generally run about $2,000 a week. Patients then sign their blank insurance forms and the clinic operators turn them over to NAHIC in Houston for processing.

NAHIC sends bills to insurance companies on behalf of patients, often listing the coffee enemas, the intravenous hydrogen peroxide, the Laetrile and the other nostrums common to the Tijuana clinics as “chemotherapies” followed by cryptic initials that Garcia says are misleading.

Laetrile, for example, which has been dismissed by the mainstream medical community as having no value in treating cancer, is listed by NAHIC on insurance claims as “Chemotherapy AMDL.”

But, said Cameron Frye, president of NAHIC, the initials AMDL are simply shorthand for amygdalin, the generic name for Laetrile, and not an attempt to disguise the treatment. Frye also cited a handful of court cases that he said support his contention that patients have a legal right to insurance coverage of unorthodox medical treatment.

But Grace Monaco, a Washington-based attorney specializing in defending insurance companies against claims for payment of unorthodox medical treatment, said the cases Frye cites have no precedent-setting value and involve older insurance policies containing vague language. The courts, she said, have consistently upheld the legality of contract language in most current health insurance policies that clearly exclude coverage of unconventional medical treatment.

Philip Hilder, attorney in charge of the Houston office of the Justice Department’s Organized Crime Strike Force, agreed with Monaco.

“I think what Frye is doing,” Hilder said, referring to Frye’s citation of court cases, “is just a subterfuge to bully the insurance companies into paying.”

Claim Processors Warned

Some insurance companies have become aware of the unorthodox practices of Tijuana clinics and have warned their claim processors to be on the alert for claims from the facilities, but the addresses of the clinics are usually listed on the claims as post office boxes across the border in California where some clinic operators have offices and vitamin distributorships.

Frye maintains that it is simply more efficient for the clinics to get their mail north of the border.

Frye started his company about two years ago, he said, after being involved in a Houston research institute with Dr. Stanislaw Burzinski, a controversial physician who treats cancer patients with a medication made from human urine. Frye said Burzinski, whom he considers a “genius,” obtained urine for the medication from vats connected to urinals in a prison and the popular Gilley’s nightclub.

NAHIC sends bills to insurance companies for one week of treatment at a time. When the patient receives a week’s reimbursement from an insurance company, NAHIC then bills the patient for 16% to 20% of that amount. The patient is informed that NAHIC will send in the next week’s claim after it receives payment from the patient.

“Our invoice of 20%,” said an NAHIC bill that a former patient made available to The Times, “is now payable and must be paid within five days if you wish to receive a 4% discount for prompt payment which will reduce our fee to 16%. After we receive payment for our invoice, your next claim (if any) will be forwarded to your insurance company and another check will be sent to you very soon.”

Patients indicated in interviews with The Times that they were unaware of the methods used in filing the claims.

In addition, the NAHIC has billed for treatment when a patient was not at a clinic, Garcia alleges. Frye denies any intentional claim for overpayment.

Hydrogen Peroxide Injections

In one instance, a middle-aged woman from the Chicago area, who asked that her name not be published, told The Times she was diagnosed at the Tijuana clinic of Kurt W. Donsbach last fall as having candidiasis, a fungal infection. She was treated with hydrogen peroxide injections and other nostrums.

The woman said she paid about $4,250 for a three-week visit to the clinic between Nov. 30 and Dec. 20 last year.

Her insurance company was billed by NAHIC for $7,125 for the period Nov. 30, 1986, to Jan. 3, 1987. When the woman returned home from the clinic--feeling as badly as when she had left, she said--she began receiving reimbursement checks from her insurance company, which pays about 80% of medical costs.

“I think they (NAHIC) submitted it by the week,” she said. “And every time we received a payment, we received a bill from them.”

The woman paid NAHIC its percentage after receiving each check.

She said that after receiving insurance reimbursements for the entire period she was treated at the clinic, she received another payment from her insurance company for about $1,000 for the period Dec. 20 to Dec. 27--the week after she left the clinic.

“We received a check which we returned,” she said, “because my husband said he doesn’t want any part of any kind of unscrupulous doings.”

Then, she said, an NAHIC official phoned.

“They called and said something to the effect that certainly we had other expenses besides (clinic fees). . . . They thought we were a little strange because we didn’t want to get all the money they could get for us. . . . They even wrote and asked if they couldn’t reissue us the check we returned.”

Payment Returned

Later in the year, the woman said, NAHIC sent in another claim for still another period of time beyond her last day at the clinic and she received another insurance company payment of about $1,000. That payment, too, she said, was returned to her insurance company.

Insurance company records indicate that the woman returned about $2,000 in overpayments.

“Obviously,” said NAHIC President Frye, “there must have been some mistake in our office.”

Frye subsequently sent a letter to The Times claiming that, after the first four claims were processed, the patient’s husband requested that NAHIC bill the insurance company for two more weeks, but later said a mistake had been made.

“It is not unusual for patients to forget the instructions they have given us,” wrote Frye, “and, of course, we pay the price of this forgetfulness.”

Aetna’s Garcia said an insurance company sometimes will spot a claim for treatment at a Tijuana clinic and deny payment. But NAHIC is persistent.

Take the case of Lester Barnard of Redding, Calif.

Barnard, 73, a retired electrician, runs a small vitamin and herb distributorship in his home along with his wife of 53 years, Rolene, also 73.

The couple are militant in their belief in alternative medicine.

When Lester Barnard felt lumps on his abdomen in February, 1986, he got in his pickup truck and headed for the Rosarita Beach Clinic in Tijuana out of fear that he had cancer and afraid that his own orthodox medical doctor might order a biopsy.

On Feb. 28, at a Tijuana clinic, Barnard was diagnosed via drops of his dried blood in a microscopic examination procedure that reputable blood analysts say is utterly worthless.

Content of Diagnosis

“There is (sic) circulation problems,” said the diagnosis. “Also signs of hardening of the arteries with some heart stress. The body environment is very susceptible to cancer. There is high levels of carcinogenic activity.”

Clinic records and an interview with Barnard indicate that he was put on a diet of herbal teas, lemonade, laxative capsules and a “detox” formula containing apple juice, distilled water and powdered herbs.

Barnard said he was also given therapy via lamps equipped with different colored plastic lenses, hot baths, colonics, massages and intravenous injections of an unknown solution.

Toward the end of the week, a doctor on the clinic staff told Barnard that the lumps on his abdomen were caused by a hernia.

Barnard decided to go home and have his doctor in Redding operate on the hernia. And, like many patrons of these clinics, he was pleased with his treatment in Tijuana:

“If I ever have another problem,” he said, “that’s where I would go.

The cost of his week’s stay: about $2,000, paid in advance, plus a couple hundred dollars worth of vitamins and supplements to take home.

The clinic is not approved for coverage under Barnard’s Medicare policy, so North American Health Insurance Coordinators of Houston, in April, 1986, billed Barnard’s supplementary insurance policy, handled by Aetna.

NAHIC said in a cover letter that the claim was being submitted to Aetna because Medicare does not cover treatment in foreign countries.

The claim was for $2,195 for services performed at Rosarita Beach Medical Clinic during the period Feb. 28 through March 6, 1986.

It indicates that Barnard was treated for cancer of the prostate. While Barnard said he received no chemotherapy at the clinic, the claim lists, among other charges, six treatments of “Chemotherapy ANTX” every day at $45 per treatment during Barnard’s visit.

More Information Requested

Aetna requested more information about the alleged chemotherapy.

An Oct. 1 letter to Aetna from NAHIC said Barnard suffered from lupus erythematosus--a sometimes fatal long-term disease that involves swelling of blood vessels and kidney disorders. The letter goes on to say that Barnard was treated at the clinic with “a nontoxic chemotherapeutic agent. . . .”

Enclosed with the letter was a medical history with Barnard’s name on it indicating that he had checked into the Rosarita Beach Clinic on Feb. 28, 1986, complaining of “joint pain, fatigue, forgetfulness and poor appetite.”

“He was found,” the history continued, “to be allergic to wheat, sugar, rice, milk, citrus, chocolate and rye.”

Aetna received still another version of Barnard’s medical history from NAHIC President Frye on Dec. 24.

Frye’s letter said that Barnard had been unsuccessfully treated by orthodox medicine for cancer of the prostate.

“The patient was then told by the family doctor,” wrote Frye, “that relief might be acquired by taking a natural nontoxic chemotherapeutic drug. . . . This is what the patient received and this is why we believe the claim is valid and should be paid since it was recommended by this patient’s own doctor.”

Barnard said, however, that his family doctor is not even aware that he visited the Tijuana clinic.

Last Jan. 17, Aetna wrote to Frye telling him that the so-called chemotherapy allegedly administered at the clinic does not qualify for coverage.

Then, last Feb. 26, Aetna received a new claim from NAHIC for Barnard’s stay at the clinic.

This time the bill totaled $3,127--$932 more than the original claim--and covered the period Feb. 28 to March 4, 1986, rather than Feb. 28 to March 6, 1986.

The new bill listed charges for a semiprivate room at $225 a day and, among other items, five treatments of “anti-cancer agents MTX, 5-FU, ORX” at $265 a treatment.

“They know that semiprivate rooms are medically accepted,” said Aetna’s Garcia. “What they did was restructure the claim form, (thinking) . . . ‘Let’s start over and see if this goes through.”’

Discrepancy in Amounts

In his letter to The Times, Frye said the discrepancy in the amounts listed in the two bills was due to an error by the clinic.

Frye denies responsibility for diagnoses listed on claims. “In reviewing this file,” he wrote, “I see that Mr. Barnard’s diagnosis was cancer of the prostate. I’m sure you understand that we must rely on the patient and physician to supply us with the correct information. . . . “

Sharon Reynolds, health educator at Rosarita Beach Clinic, told The Times that, although she was not employed at the clinic at the time Barnard was treated, chemotherapy is not used at the clinic. She specifically denied that the clinic used the types of so-called chemotherapy that Frye listed in the bill to the insurance company.

In the meantime, some otherwise skeptical patients have become convinced that the treatments offered at the clinics must be effective or insurance companies would not pay for them.

Last summer, Joan Harasen from the town of Wynyard in Saskatchewan Province of Canada, was diagnosed by conventional physicians as having a primary cancer of the kidney and a secondary cancer in the lung.

“Our cancer doctors didn’t give us much encouragement,” said her husband, Len, a hospital administrator. But the Gerson Clinic in Tijuana did give them encouragement when they telephoned, said Len Harasen.

“I guess the words . . . to my wife were, ‘We’ll get you better in no time,’ ” recalled Harasen, who said he was at first skeptical of the clinic, which specializes in coffee enemas and vegetable juice diets.

The Gerson Clinic’s promotional literature claims that many insurance companies reimburse patients for the cost of treatments. But the Harasens’ insurance policy, they learned, would not cover the treatments, which cost about $2,000 a week.

Nevertheless, Len Harasen decided to take his wife there anyway.

‘Certain Legitimacy’

“I was told by (the Gerson Clinic),” he said, “that some American insurance companies cover this place. And, to me, this was an encouraging sign because I believed that if the American insurance companies are covering it, there must be a certain legitimacy to it.

“Frankly, I felt after talking to them that if I didn’t give it a shot I would probably never be able to live with myself again.”

So last summer, Len Harasen took his wife to the Gerson Clinic in Tijuana.

“I think when we left Mexico, her physical condition was worse than when we came,” Harasen said last month.

Still, like most Tijuana clinic patients, he saw hopeful signs in medical test results. “Right now,” he said, “she is in a fair amount of physical distress. . . . Physically, she doesn’t seem to be progressing at this point. But clinically things seem to be happening.” Not long afterward, Joan Harasen was hospitalized.

“She’s not very well at all,” her husband said last week. “We’re basically just trying to keep her comfortable.”