Hi all, I am new to DD and this is my first post on this site. I first noticed a nodule in June 2010 when I thought I had bruised a tendon while weightlifting. I stopped lifting weights but the nodule didn't go away and actually seemed to be growing. Now there is some tightening in my palm and what appears to be a nodule forming just below the PIP joint on my ring finger. I had been denying that it was anything more than the early stages of trigger finger but looking at images online, I'm certain that it is Dupuytren's. At this point, I do not have any contraction of the fingers but the disease appears to be very active and I expect to experience contraction within a few months.

My GP was kind enough to refer me over to a hand specialist and I am waiting on a call from him/her to schedule an appointment to confirm that I have DD (is it called DD prior to contraction?). I have three children, the youngest of whom is a nearly three year old boy. I do not want to wait for contraction and reach the point where I can't play baseball with my son. After reading about therapies here and elsewhere, I am interested in RT as my initial course of treatment. However, I have not really seen any posts here by anyone who has received RT in Northern California (I'm in Sacramento).

Is there anyone on this site who can tell me about their experiences with doctors in Northern California? I will be attempting to get a recommendation of RT from the specialist and then will follow up to see if I can get approval from my health coverage. However, I feel like it's a race against time and I don't want to bang my head against a wall if I would be better off just booking a ticket to Germany and paying for RT out of pocket. Any advice would be appreciated!

I just wanted to reply to your statement about paying for RT out of pocket if you go to Germany. I don't know about your health plan, but I have a Blue Cross PPO and it covers medical treatment in other countries. I am not sure what percentage it will cover, but since the treatment is so much cheaper in Germany, I doubt that my out of pocket will be much higher, if at all. You'd have to check with your plan to know for sure, though.

I received RT in San Diego last year and needed retreatment this year, so I decided to go to Germany this time. I made the decision on a medical basis, not economic, but I don't think the costs will be that different (there was no RT specialist in my local area with experience with this, so I would end up paying travel one way or another).

I just posted a new thread on my Germany experience if you're interested.

In any case, good luck!

Maddie

Thank you for the response, Luba. I had seen the links to Drs. Chang and Gottschalk on this site. I also found a thread here about Dr. Chang and it sounds like the person who dealt with him had an excellent experience. I'd love to hear if there is anyone out there who has experience with Dr. Chang. Also, I'm curious if anyone has advice on how to convince their healthcare provider to pay for preventitive treatment early, instead of costly surgery later. I'm worried about having to get past two hurdles - first with getting a hand specialist to recommend RT and then with getting my provider to approve it.

Bill,

I believe the trick to getting your RT covered is to get the radiologist/oncologist to request the medical necessity for the treatment. When I went for my first consultation with Dr. Crimaldi in Charlotte, NC, he first verified the DD diagnosis from the hand surgeon. Then he said I was a candidate for RT, and while I was there, they called the insurance company and checked my benefits and requested approval for an MRI (I have to have preapproval for scans). They then gave the insurance company the codes for the RT and made sure it was covered by my insurance. The doctors and billing specialist know what to say and do to get coverage, after all that is how they get paid. If you get the doctors office to verify coverage, then there are no questions as to payment. If your radiation doctor carries your insurance plan then it is up to them to verify coverage. To me the cost of the visit with Dr. Crimaldi (about $200.00) was well worth it because I got to ask a ton of questions about the treatment, the procedure and they made sure I had insurance coverage. When I walked out of there all I had to do was plan for the treatment. They were able to tell me a ball park number of what my actual out of pocket would be. If you need preapproval for the treatment, they take care of that while you are there in the office and you find out immediately yes or no. That fee of $200 was worth that peace of mind.

I also went to Dr. Crimaldi on my own without a referral. The hand surgeon was of no use other than the diagnosis because he said to do nothing until I had enough contracture to warrant surgery and said there were no other treatments available. NO one would refer me to a radiation/oncologist.

I would recommend you first get the diagnosis of DD or Dupuytren's contracture in writing, take that diagnosis and then go to the RT specialist for treatment and let them get it approved.


Lori

I have found the decision made by the insurance company, in this case Aetna, is based on the diagnostic code not the CPT codes such as radiation delivery, etc. I just received an answer for my request for a pre-determination of benefits and all services for DT are covered based on the codes used by VCU. Radiation for LT is not covered, it’s considered experimental. I believe someone is collecting codes that have resulted in successful coverage, I will send the codes for Aetna along.

LindaM