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RT in the US for DD and insurance companies
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03/07/2011 18:51
lauriw 
03/07/2011 18:51
lauriw 
Re: RT in the US for DD and insurance companies

I just found out that I won my appeal with BCBS in Iowa. I was very aggressive with my appeal and I think they knew that I was not going to go away.
LauriW

03/07/2011 19:25
McCoy

not registered

03/07/2011 19:25
McCoy

not registered

Re: RT in the US for DD and insurance companies

Why have you been succesful; I try to get my costs with BCBS in Hawaii;
any other aspects to consider there ??

03/07/2011 20:30
Maddie 
03/07/2011 20:30
Maddie 
Re: RT in the US for DD and insurance companies

Congratulations Lauri!!!

03/07/2011 21:28
lauriw 
03/07/2011 21:28
lauriw 
Re: RT in the US for DD and insurance companies

I did a lot of research and first of all was lucky enough to find a progressive radiologist who has treated other benign diseases in the past. Getting your doctor on board is the first step, but be prepared to sell your case to most doctors. I took a file with me at least 50 pages of tests and data, he asked if he could copy my stuff, I said no, I brought it for him to keep. Letting a radiologist know which of his peers are doing this in the states is very important. BCBS immediately denied our request for treatment and my doctor appealed on my behalf. He skipped the phone call with a doctor on staff at BCBS, not sure that was wise, and went right to written appeal. I don't know what he put in the appeal, but that would be medical data etc. I wrote two long letters of complaints to the Iowa Insurance Commission and had by then compiled a list of the states that I know BCBS had paid for RT for DD and other insurance companies in the US that I discovered. That is why I started that thread and bugged everyone to tell me about their state and carrier. My doctor requested an immediate response, 72 hours, and they kicked me into the 30 pile. That made me mad. So I wrote another letter yesterday, much stronger, and copied the Iowa Insurance Commission, my lawyer and the president of BCBS of Iowa. I made it clear that I would not go away. Sure enough, I got my approval today, get my CAT Scan tomorrow and am sure that I will start treatment next week or the following. You can't take no for an answer, get the insurance commission involved, you don't threaten a law suit unitl you are out of appeals with the insurance carrier or they will throw you to legal and that will slow things down.
Am happy to give more info to anyone that needs it, so feel free to ask.
LauriW

03/08/2011 03:29
flojo 
03/08/2011 03:29
flojo 
Re: RT in the US for DD and insurance companies

Hi,

State insurance commissioners would have no pull with Medicare, so all I know to do is to go through the procedures they gave to appeal. That seems unlikely to get anywhere. Since Dr. Denkler bills Medicare for NA, I'm going to call his office to see if they can guide me about how to get Medicare to recognize RT as a necessary medical procedure. That's the only thing I can think of at this point.

I don't have unlimited time to do all the follow through that I know it will probably take.

This is beyond my pay grade dealing with medical insurance appeals, especially Medicare.

02/28/2012 18:51
callie 
02/28/2012 18:51
callie 
Re: RT in the US for DD and insurance companies

Does anyone have the diagnostic codes and procedural codes for RT for their Dupuytren's? The codes change frequently, so older codes are probably not valid.

I am interested since the nodule on my hand has become active within the last month. I have contacted insurance and our oncology dept at local hospital to see if this is doable. Any thoughts? Am I wasting my time going to our local oncology department?

02/28/2012 21:25
flojo 
02/28/2012 21:25
flojo 
Re: RT in the US for DD and insurance companies

Callie,

I think any oncology department can do it if they are interested, but I know others disagree with that.

I found Dr. Keterelos open to my questions, suggestions, and interested in what I knew about it. I think any good oncologist can do this. We know the protocol options and can ask questions. I asked Dr. K what protocol he would use and why. I asked why he didn't use the 3 x 5 and months later another 3 x 5. He had studied research and knew the studies well and based his treatment plan on the research he found most valid.

Even if you decide the local oncology department is not where you want to go, you can still learn from any experience like that.

Good luck. If you'd like to contact me about any specifics, send me a private message.

02/29/2012 19:40
lori 
02/29/2012 19:40
lori 
Re: RT in the US for DD and insurance companies

Callie,

the codes do not change that often. I work in a field that uses CPT codes and they rarely change. They are published in a CPT code book every year and are accessble online. If use use the search function, you will see several of us have posted the CPT codes. You can check online by googling CPT and the code number to see if a change has been made.

Lori

02/29/2012 20:07
callie 
02/29/2012 20:07
callie 
Re: RT in the US for DD and insurance companies

I just passed on what our insurance people told me. I gave them a couple of the numbers from our forum and they couldn't find them.

It won't matter they said. They will just go from what the doctor submits. I am not optimistic about this getting through Medicare and our insurance. But it should be an interesting experience. My hand is textbook right now for RT. I will keep the forum posted.

If they don't pay for RT, I will wait for 40 degrees contracture and have surgery.

Edited 02/29/12 22:10

03/01/2012 00:48
hammer 
03/01/2012 00:48
hammer 
Re: RT in the US for DD and insurance companies

Why not a needle release at 20 degrees they r only 800 bucks?

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