Today, June 7, 2008, I received a denial by my insurance provider, Health Partners of Minnesota (an HMO), of pre-authorization for N.A. for my Dupuytren's Contracture in both hands. Their reason for denial is "...it has been determined to be experimental/investigational...". My primary care MD submitted to my HNO for treatment by Dr. Eaton at the Hand Center in Jupiter FL.

I intend to appeal and my questions are:
1.) are any users of this forum aware of any others who have been successful in obtaining coverage from their providers, e.g., Blue Cross-Blue Shield, Prudential, etc.;

2.) any suggestions for the appeal process. I've researched this site and found a 5/11/2006 post from Steve, in which he includes his actual letter referencing CPT code 20640 and Meicare coverage.

3.) Shouldn't the Medicare approval be sufficient precedence?

Thanks to any who can assist me in this appeal.

From another post on this site, here's a link to the Mayo Clinic website which lists NA as a treatment. Ask your insurance company to refute that!

http://www.mayoclinic.com/health/dupuytr...0732/DSECTION=7

Two weeks ago my HMO, UCSD Medical Group, gave out of network approval for NA. My hand surgeon and I had been communicating since January, 08 about NA and he said he would submit a referral, but my insurer, Pacific Care, said I would have to see my Primary Care doctor (who knew nothing about Dupuytrens). I made the mistake of mentioning to her a particular Dr. at UCLA referred by my hand surgeon at UCSD. There is no one in San Diego who performs NA through my medical group and so they denied it but gave a conditional approval to have hand surgery with my current hand surgeion! I then had to go back to my hand surgeon, who then submitted a request for authorization without mentioning a particular Dr.
and it was approved. I recommend not mentioning a particular Dr., just the procedure which is much less costly for the insurer and less invasive for the patient. Now my medical group said I would have to ask my hand surgeon to refer me to a particular Dr.! Can you believe it? He initially referred me to Dr. Eaton, but when I asked if there was someone closer, he found Dr Benheim at UCLA with whom I have been communicating since February. I had a rebuttal ready with educational information about Dupuytren's to submit to my insurer in the event that they refused my hand surgeon's referral. Good luck!