I haven't looked at this site for a long time -- it seems much less disabled by spam. I couldn't find anything specificallyon my topic, so hopefully it hasn't been covered recently.

Background - my Dupuytren's has been a nuisance for over 10 years now. I first had NA performed by Dr. Lermusiaux in Paris - I did this twice, around 2-3 years apart. A couple of years ago I decided to have NA done in the US by a Paris-trained physician. I had both hands done at different times a few weeks apart. I am not going to use names, because they are irrelevant. The procedure was successful and all was well.

Here is the issue - my insurance company, CIGNA, reimbursed the doctor and the facility in which the procedure was performed. Subsequently CIGNA came back to the facility and recouped their reimbursement basically claiming that the procedure was unproven technology/intervention. I am still fighting this two years later. Interestingly, they have not gone back to the physician. Meanwhile I have returned to Paris to have NA from Dr. Badois, again successful and a good experience. I will not seek this treatment again in the US. (Don't get me started on this, as it is a symptom of the dysfunction and ineffectiveness of our health systems.)

Has anyone else had experience with CIGNA reimbursing or refusing to reimburse for NA? Has anyone gone through the claims process with CIGNA? Any related experiences would be appreciated.

Thank you.

It's ironic that they rejected the treatment as "unproven" when you could walk into their office, lay your hands on a desk and show them that in fact it worked quite well.

I had a problem with Palo Alto Medical Foundation of Santa Cruz initially denying my request for radiation. Although my health insurance was Health Net, they never had the chance to approve/deny coverage because Santa Cruz refused to consider it initially. (I felt I had a pretty good chance of eventually getting approved as Health Net had allowed others to get radiation per Dr. Tripuraneni's staff).

My advice from my own experience is persistance, data, research, and assistance.

Persistence in calling and asking why it wouldn't be covered and what they needed.
Data in finding and printing out everything I could on the treatment. Making an appointment with Dr. T in San Diego to discuss my options and paying for it out of pocket.
Research in learning how others have gotten approval after being denied by their health insurance.

The latter two were mainly done using the internet.

Finally, the benefits person- the advocate for health insurance - at UC Santa Cruz was extremely helpful to me and gave me advice. One bit was that they would prefer I use an in-network provider which is why after the radiation was finally approved, I went with Dr. Chang in Palo Alto vs Dr. T.

As I've posted before on this site, it was practically a half-time job before I got approval.

Good luck to all of you.

Diana

It's very unfortunate that the CIGNA web site contains such blatant misinformation. Obvously that material was provided by a conventional hand surgeon who was uninformed about the procedure, or unfairly biased against it. There are a couple of points that I'd describe as simply untruthful.

Health insurers have to make policy somehow, and have to rely on paid medical experts who aren't perfect. The question I have is, how does this material - and the policy it supports - ever get changed? Is there a path by which newer or better information can be admitted, causing policy to be updated?

Health insurance company employees have strong financial incentives to deny coverage whenever possible and in so doing maximize company profits. In 2014 it will be possible to shop around with other insurance providers and not worry about a pre-existing condition.

All you can do is continue to appeal the decision and take up as much of their time, especially upper management's time as possible. Letters to the president, VP's, board members, and the like will make you someone they want to have go away. You can also take them to small claims court as the dollar amount of a NA procedure is going to be less than the maximum allowed.
They expect you to quietly go away but don't do it.

It was cheaper for me to go to Germany for XRT as a US citizen than to get the same treatment performed at the UCSF Medical Center (teaching hospital) in San Francisco even with my Blue Cross / Anthem insurance coverage. That is simply the way health care works when capitalism puts profits above people in our laissez-faire plutocracy that so many people mistake for a democracy.