Re: We've broken the Sound Barrier.

This morning I printed off the 'Instructional Courses' from the ASSH website then underlined Dr Eatons presentation along with the words Dupuytren's and Needle Aponeurotomy. It printed out nicely with the Convention logo at the top.

I had an appointment with a healthcare worker who on previous occassions was cynical when I tried to tell him about NA, 'I don't involve myself with internet nonsense'.

Today I was gentle when I started with 'Oh do you remember?..... I've brought the info incase you might be interested'. His initial reaction was a combination of negativity, suspician, bewilderment and then curiosity.'


I put the pages next to my purse on the chair (picture side up) then said no more. As he worked on me his eyes kept darting back to the picture. I could see him softening, finally he stopped what he was doing, picked up the list and flipped through it double checking the title first. When he was done reading it he said, 'Well, it must really be true. I honestly didn't believe all this stuff but if they are giving time it must be worth while.'

Then he started asking me all the usual questions re: Why not just surgery? Nerve damage. He took the website addresses and told me would check them out then give them to his patients who had DC if the situation was appropriate.

We have a new believer. :-)

Thought you would all like to hear this story. The power of the presentation is going to work far beyond the audience that hears it.

Frances

Frances, I missed to congratulate you for your success (it's a pain that we can't edit our posts!). That was carefully planned and executed. Well done!

Wolfgang

Thank you Ken and Wolfgang for your kind words. Frances

The following is an edited letter that I sent to my HMO when I successfully appealed their denial of coverage of NA in early 2005. I think I posted it on this website once before, but it has been a while. Perhaps you can use some of it when battling for your coverage.

Steve

To Whom It May Concern:

I received a denial of request for coverage (dated February 21) for a procedure I had performed to correct Dupuytren’s Contracture. The denial was on the basis that “the requested service was considered experimental treatment.” I would like to contest this denial and, before going through the appeals process, have the physician who made this determination review my objection, and, if denied, explain in writing his rationale.

The procedure to correct my condition was a needle fasciotomy. This is not an experimental treatment, as evidenced by the following:

1) There is a CPT code for this procedure:
Diagnosis: ICD Code 728.6 (Dupuytren’s)
Procedure: CPT Code 26040 (Percutaneous Fasciotomy)
2) Both Blue Cross and Medicare reimburse for this procedure.

While open-hand surgery was certainly an effective option, I selected this procedure in preference to open-hand surgery for four reasons:

1) Dupuytren’s is a chronic disease with approximately a 50% recurrence rate after treatment. The needle procedure can be repeated almost indefinitely while surgery can be repeated once, at most.
2) Recovery periods are drastically different. Open-hand surgery can result in recovery times of over 4 months with extensive therapy (The Indiana Hand Center, which does not do needle fasciotomy, indicates that splinting might be necessary for 6-9 months). Recovery time for needle fasciotomy is less than 14 days. In my case I was driving the next day, using both hands on the computer 3 days after the procedure and returned fully to work 9 days later. My occupation as a dairy consultant demands some level of physical work, including the lifting of 50-lb bags. An extended layoff would severely jeopardize the financial security of my family.
3) As local anesthesia is used, the risks of general anesthesia are avoided.
4) The risk of complications (nerve damage, loss of blood circulation, skin damage, infection, loss of mobility, hematoma, bone loss) during and following surgery has been estimated at 20% (Sibbit and Sibbit, 2001). Complication levels this high have not been reported for needle fasciotomy.


The reasons I selected Dr. xxx to perform this procedure are many:

1) His certification: He is board certified by the American Board of Surgery, with a certificate of added qualification in surgery of the hand, and is a fellow of the American College of Surgeons.
2) His medical education: He received his medical degree from a top medical school, Washington University in St. Louis, where he was president of his medical school class. He received a hand surgery fellowship at NYU and a hand and microsurgery fellowship at the Microsurgery Research Centre in Melbourne, Australia. He has 20 publications as primary or co-author.
3) His specific training: He was trained in needle fasciotomy by doctors who have been performing this procedure for approximately 30 years.
4) His experience: He has performed nearly 1000 needle fasciotomy procedures; he is also skilled in wrist arthroscopy, replantation, microsurgery, minimally invasive hand surgery, and joint replacement in the hand, and so has extensive knowledge of hand anatomy and function.

To this date, approximately one month after the procedure, I am completely satisfied. My contracture was reduced from 55 degrees to 10 degrees and remains at 10 degrees thus far. I have both pre-operative and post-operative photographs taken by Dr. xxx, should you be interested.

It should be of additional interest to you that open-hand surgery is 10-20 times more expensive than needle fasciotomy.

Finally, my appeal is not only for myself, but also for the thousands of people suffering from this debilitating disease – one estimate is that 10% of men over 50 will be affected. They should not be denied effective and minimally invasive treatment because their insurance will not provide coverage.

I am looking forward to your reply.


Sincerely,

Ken, here is part of what Dr. Eaton hands out to patients regarding getting insurance to pay, he cites a medical study. I thought maybe this info will be of some help to you:

My insurance company tells me that they won't cover this because...

Other surgeons do Dupuytren's surgery.

------That's true, but if you want a needle aponeurotomy rather than open surgery, ask your plan representative for a list of other providers who perform this procedure, and mention that the total cost of traditional outpatient Dupuytren's surgery, including facility, anesthesia, and therapy will be ten to twenty times that of an office needle aponeurotomy. Mention that twice.

This is cosmetic surgery, and so is not covered.

-----Absolutely not true. Don't accept this explanation. Correction of contracture has been reported to improve hand function and dexterity lost to the disease (see the publication by Inha R, Cresswell TR, Mason R, Chakrabarti I: Functional benefit of Dupuytren's surgery. J Hand Surg [Br]. 2002 Aug;27(4):378-81). Advanced untreated Dupuytren's contracture has led to finger amputation for some patients, and Dupuytren's alone has qualified some sufferers for permanent complete medical disability. That's not cosmetic, period. Speak with your plan representative's supervisor, get their name, and let them know that you will be naming them personally when you write your insurance commissioner to complain that your plan is using a fraudulent explanation to deny a medically necessary treatment which is covered by Medicare. Contact your state insurance commissioner.