OK, I just got the first notification from my insurance company and they said that they would not cover RT for Dupuytren's. Their reason was that it is considered "experimental". So, I guess I'll start making phone calls to see where this will go. It is too bad because my hand (a newly formed nodule right on the surface and a developing cord - no contracture) is in the perfect status for RT and changing quickly.

I have already started the appeal process. It should be interesting. I am not applying for Medicare coverage.

Edited 04/23/12 17:00

Callie,

The last person I rememer compiling a list is "lauriw" form this forum. She won her insurance appeal. I believe she also had an attorney ready to become involved, because the reserch clearly indicated that RT was not "experimental." If I remember correctly her appeal was denied and she took it past the appeal process. Good luck, I know every time I read about insurance turning someone down on this forum I become more concerned should my DD become active again and I have to go through fighting them to pay for it.

Lori

I am getting copies of the Scripps billing to Medicare and Anthem Blue Cross as secondary insurance to LLUMC. Their insurance department already contacted Medicare but can't get a preauthorization. They will compare the codes Scripps used to what they would use.

Scripps Green Hospital was paid by Medicare and Anthem Blue Cross for the radiation therapy doses administered. That was the big ticket item and it was paid by Medicare and Anthem BC. I haven't received those yet, but expect to get a copy of their billings this week. Scripps Clinic sent their billings for the radiologist that were not paid.

I can fax or mail you a copy of these pages as part of your arsenal. We are all in this together. If we get full documentation together, we can share it as others come up against denial.

flojo, my provider said that medicare never gives preauthorization. I assume that is correct, but not sure.

Lori, our insurance is with "ODS has remained a pioneer in affordable health plans. With our innovative, evidence-based health plans, our diverse networks and member programs, and our superb customer service, ODS continues to be the health leader throughout the Pacific Northwest".

Their total rejection is based entirely on lack of formal acceptance for RT for Dupuytren's in the medical community. Basically, no one in the medical community is pushing RT as an accepted/documented early intervention for Dupuytren's.

I think a real problem is that it is so expensive without the necessary documented success rate. I called one of the providers listed here in the drop down menu and they said their cost was between $13,500 and $14,000. If I paid cash (and didn't have insurance coverage) they would give me a $2,800 discount. That seems extremely high, but we all are aware of that.

A real problem just from the information on this website:

"After their initial growth, the small nodules or cords typically keep their size for about 5 - 6 years. Then the contraction process starts to bend the fingers. It is usually only at this late stage that patients start to seriously consider an efficient therapy, e.g. surgery. It is less well known that radiotherapy is highly efficient in the early stage of this disease."

and on the same page, "It is worth noting that not every patient with Dupuytren's disease will develop bent fingers. Specifically when the disease starts beyond the age of 60 many patients never get beyond nodules and possibly cords, and don't experience a severe extension deficit of their fingers."

http://www.dupuytren-online.info/dupuytr..._therapies.html


It is just so expensive here in the U.S. that insurance companies, for practical reasons, are hesitant to approve a procedure that doesn't have more documented outcomes. I still haven't figured out why it is so expensive here, but I guess that could be said for all procedures.