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Forum for Dupuytren's and Ledderhose 
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  • Insurance Coverage in the States
    • Insurance Coverage in the States
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    03/14/2005 23:13
    Anon

    not registered
    03/14/2005 23:13
    Anon

    not registered

    		 Insurance Coverage in the States

    Hi to all the Americans out there,

    Can you please list the name of your insurance companies and whether or not they paid for your NA with the accompanying code so newbies can have that info quickly at their finger tips?

    Thanks,

    Anon
    03/14/2005 23:27
    Dr. Wicks

    not registered
    03/14/2005 23:27
    Dr. Wicks

    not registered

    		 Insurance coverage for DC in the States

    Anon et al,

    Most all good insurance companies in the states cover the NA procedure for DC. In addition, Medicare, if you are covered,also covers the NA procedure.

    Diagnosis: ICD Code 728.6 for Dupuytren's.
    Procedure: CPT Code 26040 (Percutaneous Fasciotomy).In unusual cases, the procedure may include CPT 26060 Tenotomy (for bountonniere deformity) or 26525 Capsulotomy (for severe PIP joint contracture).



    03/15/2005 23:25
    Kristen 
    03/15/2005 23:25
    Kristen      		Blue Cross reimbursement

    I have Blue Cross Blue Shield of Florida. I had 2 fingers done by Dr. Eaton. He charged $200 for the office visit and $500 for each finger. BCBS allowed $429 for each finger, minus 40% since Dr. Eaton is not a BCBS provider. They would allow nothing for the $200 office visit charge, nor would they reimburse a nickel of the $160.00 splint. I suppose the bean counters in the Jacksonville office determined the splint unnecessary. That's how it goes for those fortunate enough to have health insurance - though sometimes it doesn't seem a whole lot better than being uninsured. Bottom line - I spent $1360 and insurance covered $514.
    03/15/2005 23:00
    Peggy

    not registered
    03/15/2005 23:00
    Peggy

    not registered

    		 Medicare denied my claim

    I received the notice today that Medical denied my claim for my NA procedure with Dr. Eaton on 2/10. I have not heard from my secondary coverage - Blue Cross. In checking the statement, they used code 26040-F-3 and 26040-F-451) for the procedures, which is correct. I can't figure out why it was denied. I will be calling them to see if they can explain it to me. Has anyone else had their claim denied?

    03/15/2005 23:28
    Peggy

    not registered
    03/15/2005 23:28
    Peggy

    not registered

    		 correction

    I meant to type Medicare - not Medical. oops!
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    Fasciotomy   Jacksonville   determined   Percutaneous   uninsured   correction   accompanying   Capsulotomy   Coverage   bountonniere   procedures   reimbursement   unnecessary   procedure   statement   contracture   26040-F-451   Medicare   companies   Insurance