I certainly do not want to present myself as an expert , although I am a licensed insurance agent since 1979, but I thought I might make a suggestion to those of you who are trying to do your insurance homework up front prior to the NA procedure I would suggest you obtain the diagnosis code(numbers that represent the description of your condition) and the procedure code(the numbers that indicate the procedure which is to be performed). You probably can give the zip code of your doctor and the anticipated charge...and they may tell you how much is a covered and reimbursable expense. I would not suggest discussing the NA verses other techniques and tools that are used in other versions of the treatment...simply because just using the two codes mentioned previously will likely give the insurance company the info they need to pay or reject the claim. You may run into a situation where the medical directors for the respective companies are not aware of the NA version using this particular tool! And why should they know...when so many of the hand surgeons have not embraced this technique.
But if they know a fasciotomy is being performed(per the codes) the discussion of NA shouldn't enter the conversation! In this case..less is more!

I realize that many people traveling out of state are likely
to either pay out of network or pay entirely out of pocket.
It is likely that until this procedure is done more widespread, the medical doctors/directors of the insurance companies are not apt to understand the cost savings in terms of less procedure costs ....never mind less recovery time.It seems silly that if bottom line dollar is a concern to insurance companies, they would welcome any procedure that is apt to benefit the bottom line! Unfortunately, the unknown....when discussed... scares the unknowing!

I might suggest a couple of things for those of you who are worried about having to shoulder the entire cost out of pocket. Calculate what your out of pocket totals would be if you went through the other techniques which require surgical facilities, anesthesiologist, greater surgeon's fees, physical therapy, and any down time from work. How does that cost compare to travel, doctor's fees, and no down time?

Perhaps those of you in a particular area could caravan, or rent an RV, charter a bus....split some of the costs of travel. Maybe use this board to gather some folks in your area or in a state on the way to FL. My impression as I see some of the notes on this board....you all have become students of this disease and the various options of treatment. The people to whom you will be appealing your cases probably only barely have heard of this newer technique... an then only due to an appeal. If you can get by with less is more....great! If not, then I suggest a mass blitz to the medical directors of the various insurance companies. Rather than spending a night or two on the board....call your local Dept of Insurance and get the Home Office of the Various insurance companies you want to write. and find out who the medical directors are..write to others besides your carrier. This is your good deed! But in addition, most medical directors are human...they probably want to be on top of the game and informed as much as their counterparts at other insurance companies. In this case...more is more! Good Luck!

From Dr. Eaton's Web Pages
Q:Is this covered by insurance? Yes.

Q:
What do I need to tell my insurance company? Your insurance company will want to know the insurance codes for your
Diagnosis: ICD Code 728.6 (Dupuytren's)
and your
Procedure: CPT Code 26040 (Percutaneous Fasciotomy - one finger)
Under very unusual circumstances, the procedure may possibly also include CPT 26060 Tenotomy (for boutonniere deformity) or 26525 Capsulotomy (for severe PIP joint contracture).

Bringing this to the top

I meant to type Medicare - not Medical. oops!!!

From what I read of your letter, getting pre-authorization is one of the reasons they declined it. Perhaps requesting the procedure BEFORE getting it might help? They you could provide some of the info that has been listed on this website along with before/after photos from your first NA.

Since there are now FIVE NA practitioners in the US and other insurance companies who do pay, perhaps this is something you could add to your pre-authorization along with info from NICE etc.....

Good Luck
Anon