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08/11/2013 15:43
wlrovin 
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08/11/2013 15:43
wlrovin
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medicare coverage
I have had dup for about a year, and I think it is getting close to contracting my little finger. I want to get RT, but am concerned about the costs. I live in California. I have medicare and United Health supplemental insurance. Does anybody know if medicare will cover the RT in any specific clinics? Also if not, what is the cost of having the procedure in California? And how good are the doctors here?
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08/11/2013 20:01
LubaM. 
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08/11/2013 20:01
LubaM.
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Re: medicare coverage
wlrovin:
I have had dup for about a year, and I think it is getting close to contracting my little finger. I want to get RT, but am concerned about the costs. I live in California. I have medicare and United Health supplemental insurance. Does anybody know if medicare will cover the RT in any specific clinics? Also if not, what is the cost of having the procedure in California? And how good are the doctors here?
I had RT at Scripps Hospital in LaJolla, CA in November 2009. At that time Medicare paid and my Blue Cross PPO paid as secondary. Since then another poster on this Forum indicated that Scripps didn't get paid by Medicare when she got treated, but other hospitals are willing to work through an appeal to get paid. Best advice would be to find out first where you want to get it done and make sure with the hospital/clinic that they are familiar with billing Medicare and know that they will get paid so you don't have to deal with it.
Since they paid for my RT don't know the cost. I was very satisfied with Dr. Tripuraneni at Scripps Hospital, especially for the RT for my Ledderhose, nodules are 90% gone. The RT for nodules on the palm of my hand was partially successful.
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08/11/2013 22:31
callie
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08/11/2013 22:31
callie
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Re: medicare coverage
Cost will be anywhere from $9,000 to $13,000. Cost in Portland, OR was right at $9,000.
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08/12/2013 01:34
moondanc
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08/12/2013 01:34
moondanc
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Re: medicare coverage
wlrovin:
I have had dup for about a year, and I think it is getting close to contracting my little finger. I want to get RT, but am concerned about the costs. I live in California. I have medicare and United Health supplemental insurance. Does anybody know if medicare will cover the RT in any specific clinics? Also if not, what is the cost of having the procedure in California? And how good are the doctors here?
Billed cost for my procedures, two hands including doctor fees was close to $25,000. Medicare apparently told the facility it was covered and then declined to cover less than half of it. Facility appealed several times but did not prevail. Medicare said to me, "since you didn't think you had to pay for it-- you don't" and so I didn't have to pay anything. This was in No. Californi-Dr. Pauling Chang, Palo Alto Medical Foundation.
Diane
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08/12/2013 02:37
wlrovin
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08/12/2013 02:37
wlrovin
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Re: medicare coverage
Thank you all for your responses. It seems that medicare is more confusing than ever. Diane, I was most interested in going to Doctor Chang since he is the closest to Fresno. Coverage aside, were you happy with his treatments? When did you have it? Did you have supplemental insurance with medicare? Did they say what they covered and what they didn't cover? And then of course if I do have to pay for it, and it seems that Portland is half the price, then maybe that would be better (I do love Portland). It seems that the more I know, the more confusing this whole thing is.
I guess the bottom line is, even if I have to pay for everything it will be worth it. If I can't play tennis I will be very unhappy.
My Fresno doctor, by the way, won't do anything until my finger is bent enough for him to snap it back. Geez.
Thank you again everybody for your help. This forum is the best thing we have got for this mysterious malady. What would we do without the internet?
Bill in Fresno
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08/12/2013 14:32
callie
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08/12/2013 14:32
callie
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Re: medicare coverage
1) The problem is that Medicare will not tell you if it will cover the procedure until after it is completed.
2) In Portland it is Dr. Cha at Oregon Clinic: Radiation Department (503-215-6029). The clinic is located at the Providence Hospital.
3) RT is not always successful, but usually helps. It doesn't prevent future nodules.
4) Dupuytren's might not have any effect on your tennis until extreme contraction which might not ever happen.
5) If it weren't for insurance I don't think I would spend the money out of pocket to have RT, but that is a personal opinion. Often Dupuytren's doesn't reach a point where it is a problem for many people.
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08/12/2013 17:16
moondanc
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08/12/2013 17:16
moondanc
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Re: medicare coverage
Hi Bill,
If you would send me your email it is a lot easier to respond to you and I'll remember to do it rather than check PMs, etc. I'd even be willing to call you to discuss it. I'm really busy right now but will have time to either answer closer to the end of the week.
I am : Moondanc@gmail.com
Diane
wlrovin:
Thank you all for your responses. It seems that medicare is more confusing than ever. Diane, I was most interested in going to Doctor Chang since he is the closest to Fresno. Coverage aside, were you happy with his treatments? When did you have it? Did you have supplemental insurance with medicare? Did they say what they covered and what they didn't cover? And then of course if I do have to pay for it, and it seems that Portland is half the price, then maybe that would be better (I do love Portland). It seems that the more I know, the more confusing this whole thing is.
I guess the bottom line is, even if I have to pay for everything it will be worth it. If I can't play tennis I will be very unhappy.
My Fresno doctor, by the way, won't do anything until my finger is bent enough for him to snap it back. Geez.
Thank you again everybody for your help. This forum is the best thing we have got for this mysterious malady. What would we do without the internet?
Bill in Fresno
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08/12/2013 17:24
moondanc
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08/12/2013 17:24
moondanc
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Re: medicare coverage
callie:
1) The problem is that Medicare will not tell you if it will cover the procedure until after it is completed.
[snip]
5) If it weren't for insurance I don't think I would spend the money out of pocket to have RT, but that is a personal opinion. Often Dupuytren's doesn't reach a point where it is a problem for many people.
Callie, perhaps you know that Medicare contracts out to each individual state to have a company handle paperwork, approvals, etc. It's not common but there are procedures covered in some states that aren't in others.
In CA almost every doctor I've ever been to has verified with Medicare ahead of time to make sure the procedure is covered. If they don't volunteer to do this, I request it as I need to know! In my case in 2009, Palo Alto Medical Foundation (PAMF) did verify that RT was covered prior to my treatment and then for some reason when they were billed decided it was not--or --and I'm a little fuzzy on this--some portion of the treatment was not covered--for sure the doctor portion. I just don't have time to look up the actual bills right now. However, because I'd initially been told it was covered, I was not responsible for ANY charges. PAMF appealed it two or three times as as I recall didn't get coverage. I've never persued asking my secondary about coverage because the standard response is ALWAYS "if Medicare covers it, we cover it." Recently, I've been finding doctors (for procedures other than DD who will not accept Medicare patients UNLESS one has a secondary.
Is Flora around these days--I'm curious what is happening with her Medicare appeal from the place she went for RT after Scripps.
Diane
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08/12/2013 19:10
ScottW
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08/12/2013 19:10
ScottW
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Re: medicare coverage
Hello: Just my 2 cents :)
Being a business owner in Oregon, with high deductible insurance, I finally opted for RT for my Dupuytren's and Ledderhose with Prof. Heinrich Seegenschmiedt in Hamburg Germany. He is well renowned in Dupuytrens circles and he has a high success rate in treating both diseases.
The total cost for a 5 day RT course, including; both extremities, multiple doctor consultations was a total of 991 Euro (or about $1318 USD). Of course, you have to add in the travel expenses to Germany.
I am not sure what Medicare might cover or as of yet, even what my insurance will cover, but I am not even coming close to my deductible limit taking this course.
Best of luck!
Edited 08/12/13 22:11
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08/13/2013 00:18
wlrovin
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08/13/2013 00:18
wlrovin
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Re: medicare coverage
As my father would say, this is all grist for the mill. The more info the better. If I don't know more about my own disabilities than my doctor than I am not showing enough interest, and deserve what I get. The one thing that I am sure of is that I am going to get the radiation therapy. Cost aside, this seems to be the only therapy that can actually stop the progression of dup, and has a pretty high success rate. Apparently it is also necessary to do it before the contractures for the best possible outcome. I am not a fan of radiation, but the statistics indicate that there is a very low possibility of ending up with cancer from it. And I can already feel my little finger losing its flexibility.
The only variable seems to be the expenses involved. If it did not require two sessions separated by 6 to 8 weeks, I would have considered taking a nice vacation to Hamburg. On the other hand, if medicare and my supplemental insurance will cover it, then I will try to have it done in Palo Alto (I can go to Germany later with the money I save--lol). If medicare will not cover it, I may need to compare prices. If Palo Alto is $25,000 and Portland is $9,000, then I think a nice trip to Portland would be cool. Either way I would have to rent a place for the 5 days, and either fly to Portland from Fresno, or rent a car to drive to Palo Alto (my electric car won't go that far).
I really feel much better about this whole thing, even with all of the variables. All of you are the reason. Any further advise that you can provide will be most appreciated. Any medicare info, any doctor info, any personal experiences that could help me through this would be great.
thank you, thank you
Your dup friend
Bill Rovin
wlrovin@aol.com
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