That second sentence, "The evidence on efficacy is limited in quantity and there is uncertainty about the natural history of early Dupuytren’s disease, which makes evaluation of the effect of the procedure difficult"

is what would make it so my insurance wouldn't cover it. The cost quoted for my RT ($13,650) they said, was more than they have been covering for surgery. They said there wasn't enough conclusive evidence that it was overwhelmingly a positive experience. They wrote a five page denial to me and didn't give me much of an angle to make another appeal. I gave them copies of the available studies and several pictures.

Callie, does your insurance company require preauthorization for RT generally? I always recommend that unless the policy says preauthorization is required for a specific treatment, that people NOT check with their insurance company in advance. I think it is a lot easier for them to say no before you've had the service. Plus, afterwards you have the provider on your side to fight for you, because they want to get paid.

Also, have you given them copies of Prof. S's studies? (The doctor in Hamburg) I think there are copies or links to some of his papers on this site.

I have had RT for Dups three times now and my insurance (Blue Cross) has paid each time. I did have to appeal one time, but the provider filed all the paperwork for me.

I think we all should fight this trend, because its absurd for insurance to not pay for the only known treatment that can prevent progression.
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Maddie

Edited 05/20/12 06:47

Obviously as individuals we each have to make the choice that is right for us. But collectively I think we should fight this type of argument from insurance companies, because it is BS. There are many many medical procedures that have not been subjected to rigorous clinical trial but are still covered by insurance because they are considered to be "standard medical practice." Some of them are not particularly effective and can even be harmful. When I discussed this issue with Prof. S, he said "where are the clinical trials for surgery for Dups?

I am not suggesting that you do anything differently, Callie - of course you meed to take the course that you feel is best for your health and finances. But I hope that Dups and LD patients as a whole continue to challenge the insurance companies on this. They will eventually have to give in because it is clear this treatment works, and there is both a logical scientific rationale and significant empirical evidence .

I think there are lots of arguments one could make, including published studies from Germany (which have been presented at medical conferences in the U.S. ; the many highly reputable medical institutions and radiologists in the U.Swho have been performing this procedure for years now with successful outcomes; the similarity to RT for other benign conditns that I would presume they cover (such as keloifs B5ut I think the fact that you haven't had the procedure yet puts you at a disadvantage. It would help if you could get your (potential) provider to weigh in.

Sorry for the typos above - writing this on my phone which doesn't interact too well with this forum.

Maddie

My provider has been involved throughout this. They have filed the appeals along with mine. They have used the codes that have been used by others. The whole situation comes down to the issue that there are no studies that have been done in the U.S. that are satisfactory for their criteria that it is other than "experimental or investigational". I have no leverage. If the costs were not so high, I think there might be a difference in their attitude, but that is only a guess.